{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T11:14:19Z","timestamp":1783509259389,"version":"3.55.0"},"reference-count":17,"publisher":"MDPI AG","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:sec id=\"st1\">\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>On a national level, heroin-related hospital admissions have reached an all-time high. With the foot being the fourth most common injection site, heroin-related lower-extremity infections have become more prevalent owing to many factors, including drug preparation, injection practices, and unknown additives.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"st2\">\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We present a 16-month case series in which eight patients with lower-extremity infections secondary to heroin abuse presented to The Jewish Hospital in Cincinnati, Ohio.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"st3\">\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Three cases of osteomyelitis were seen. All of the infections were cultured and yielded a wide array of microbes, including\n                      <jats:italic>Staphyloccoccus, Streptococcus, Bacillus, Serratia, Prevotella,<\/jats:italic>\n                      and\n                      <jats:italic>Eikenella<\/jats:italic>\n                      . All of the patients were treated with intravenous antibiotic agents, with nearly all receiving combination therapy. Seven of the eight patients underwent surgery during their hospital stay, with two undergoing amputation. Only half of the patients followed up after discharge.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"st4\">\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>This case series brings to light many considerations in the diagnosis and management of the heroin user, including multivariable attenuation of immunity, existing predisposition to infection backed by unsterile drug preparation and injection practices, innocuous presentation of deep infections, microbial spectrum, and recommendations on antimicrobial intervention, noncompliance, and poor follow-up. By having greater knowledge in unique considerations of diagnosis and treatment, more efficient care can be provided to this unique patient population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.7547\/17-159","type":"journal-article","created":{"date-parts":[[2019,11,22]],"date-time":"2019-11-22T10:55:12Z","timestamp":1574420112000},"page":"437-444","source":"Crossref","is-referenced-by-count":1,"title":["Considerations in the Diagnosis and Management of Lower-Extremity Infections in Injection Heroin Users: A Case Series"],"prefix":"10.3390","volume":"109","author":[{"given":"Sadie C.","family":"Wylie","sequence":"first","affiliation":[{"name":"Department of Podiatric Medicine and Surgery, The Jewish Hospital\u2013Mercy Health, Cincinnati, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Cullum","sequence":"additional","affiliation":[{"name":"Department of Podiatric Medicine and Surgery, The Jewish Hospital\u2013Mercy Health, Cincinnati, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Brarens","sequence":"additional","affiliation":[{"name":"Department of Podiatric Medicine and Surgery, The Jewish Hospital\u2013Mercy Health, Cincinnati, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","reference":[{"key":"i8750-7315-109-6-437-b01","series-title":"Bloomberg Businessweek,","article-title":"The heroin business is booming in America","author":"Smialek \n              J:","year":"2017","unstructured":"Smialek \n              J: \n            \n          \n          The heroin business is booming in America, Bloomberg Businessweek,May 11, 2017."},{"key":"i8750-7315-109-6-437-b02","series-title":"Drug Alcohol Depend","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1016\/j.drugalcdep.2016.04.009","article-title":"Nationwide increase in hospitalizations for heroin-related soft tissue infections: associations with structural market conditions","volume":"163","author":"Ciccarone \n              D,","year":"2016","unstructured":"Ciccarone \n              D, \n            \n            \n              Unick \n              GJ, \n            \n            \n              Cohen \n              JK, \n            \n            et al: \n          Nationwide increase in hospitalizations for heroin-related soft tissue infections: associations with structural market conditions. 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