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Papers by Kapila Marambage
Open Forum Infectious Diseases, Dec 1, 2022
Background. Injection drug-use (IDU) has increased over the past two decades and contributes towa... more Background. Injection drug-use (IDU) has increased over the past two decades and contributes towards the morbidity and mortality of opioid use disorder (OUD). Recent studies of IDU-associated infections have primarily focused on regions outside of the southern United States; however, this area presents greater barriers to
Journal of General Internal Medicine
Open Forum Infectious Diseases, 2021
Nearly 20% of people in the United States use drugs each year. People who use drugs (PWUD) are pr... more Nearly 20% of people in the United States use drugs each year. People who use drugs (PWUD) are predisposed to complex infections that require long term intravenous (IV) antibiotics. A frequent clinical quandary in PWUD is safe administration of extended IV antibiotics. Current standard of care is IV antibiotic administration in skilled nursing facilities. In this system, PWUD frequently do not finish antibiotic therapy, resulting in avoidable complications of untreated infections and increased healthcare utilization. We present a pilot study of ten patients with a history of addiction who required long-term IV antibiotics to evaluate the feasibility of self administered outpatient parenteral antibiotic therapy (S-OPAT) for PWUD. Ten patients who had a history of mild addiction and stable housing, social support and transportation were enrolled at Parkland Health and Hospital System to complete S-OPAT. We extracted demographic, drug use, clinical and access to care variables and pati...
The Residents Journal, 2012
Hypothermia is a severe, life-threatening condition that has been associated with the use of anti... more Hypothermia is a severe, life-threatening condition that has been associated with the use of antipsychotic drugs, and it is traditionally defined as a drop in core body temperature less than 35°C (95°F) ( 1). Both typical and atypical antipsychotics have been associated with hypothermia (2). There are published case reports and case series of hypothermia with antipsychotic use. We describe a patient who was admitted to the medical intensive care unit with hypothermia while his medication regimen was being transitioned from
risperidone to olanzapine.
Open Forum Infectious Diseases, 2021
Background Uninsured people who use drugs (PWUD) require extended parenteral antibiotic therapy w... more Background Uninsured people who use drugs (PWUD) require extended parenteral antibiotic therapy when diagnosed with complex infections such as osteomyelitis. They are ineligible to enroll in our self-administered outpatient antimicrobial therapy (S-OPAT) program and instead sent to a skilled nursing facility (SNF). We aim to retrospectively assess clinical outcomes of PWUD discharged from our safety net hospital to complete OPAT in a SNF. Methods Using our hospital electronic medical record, PWUD and discharged to SNF for extended antibiotic therapy were identified for the study period 1/1/17 -4/30/18. Demographics, drug use, discharge diagnosis, antibiotic therapy, discharge disposition from SNF (AMA, early non-AMA, completed), 30-day emergency department (ED) utilization, and 30-day readmission were collected for the study cohort. ED-utilization and 30-day readmission rates were analyzed by disposition group. Results While the majority of patients completed treatment (83), a sizea...
Open Forum Infectious Diseases, Dec 1, 2022
Background. Injection drug-use (IDU) has increased over the past two decades and contributes towa... more Background. Injection drug-use (IDU) has increased over the past two decades and contributes towards the morbidity and mortality of opioid use disorder (OUD). Recent studies of IDU-associated infections have primarily focused on regions outside of the southern United States; however, this area presents greater barriers to
Journal of General Internal Medicine
Open Forum Infectious Diseases, 2021
Nearly 20% of people in the United States use drugs each year. People who use drugs (PWUD) are pr... more Nearly 20% of people in the United States use drugs each year. People who use drugs (PWUD) are predisposed to complex infections that require long term intravenous (IV) antibiotics. A frequent clinical quandary in PWUD is safe administration of extended IV antibiotics. Current standard of care is IV antibiotic administration in skilled nursing facilities. In this system, PWUD frequently do not finish antibiotic therapy, resulting in avoidable complications of untreated infections and increased healthcare utilization. We present a pilot study of ten patients with a history of addiction who required long-term IV antibiotics to evaluate the feasibility of self administered outpatient parenteral antibiotic therapy (S-OPAT) for PWUD. Ten patients who had a history of mild addiction and stable housing, social support and transportation were enrolled at Parkland Health and Hospital System to complete S-OPAT. We extracted demographic, drug use, clinical and access to care variables and pati...
The Residents Journal, 2012
Hypothermia is a severe, life-threatening condition that has been associated with the use of anti... more Hypothermia is a severe, life-threatening condition that has been associated with the use of antipsychotic drugs, and it is traditionally defined as a drop in core body temperature less than 35°C (95°F) ( 1). Both typical and atypical antipsychotics have been associated with hypothermia (2). There are published case reports and case series of hypothermia with antipsychotic use. We describe a patient who was admitted to the medical intensive care unit with hypothermia while his medication regimen was being transitioned from
risperidone to olanzapine.
Open Forum Infectious Diseases, 2021
Background Uninsured people who use drugs (PWUD) require extended parenteral antibiotic therapy w... more Background Uninsured people who use drugs (PWUD) require extended parenteral antibiotic therapy when diagnosed with complex infections such as osteomyelitis. They are ineligible to enroll in our self-administered outpatient antimicrobial therapy (S-OPAT) program and instead sent to a skilled nursing facility (SNF). We aim to retrospectively assess clinical outcomes of PWUD discharged from our safety net hospital to complete OPAT in a SNF. Methods Using our hospital electronic medical record, PWUD and discharged to SNF for extended antibiotic therapy were identified for the study period 1/1/17 -4/30/18. Demographics, drug use, discharge diagnosis, antibiotic therapy, discharge disposition from SNF (AMA, early non-AMA, completed), 30-day emergency department (ED) utilization, and 30-day readmission were collected for the study cohort. ED-utilization and 30-day readmission rates were analyzed by disposition group. Results While the majority of patients completed treatment (83), a sizea...