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Summary Objectives To establish the clinical reasons for inpatient admissions among injecting drug users. To determine the frequency of behavioural issues during their care and to estimate the financial implications of injecting drug use to the health service. Methods Retrospective cohort study at University College London Hospital. Clinical, laboratory and financial data were extracted from case notes and electronic records. The cost of each admission was compared to the income received for the period of care. Results 124 injecting drug users required 191 admissions between 2005 and 2009. Skin and soft tissue infections (58%) and pneumonia (18%) were the commonest reasons for admission. Bacteraemia at admission was often not accompanied by an inflammatory response. Exposure to HIV (4%), hepatitis B (49%) and C (84%) was common. Drug misuse (16%) during admission was frequent. The cost to the NHS of treating soft tissue infections in drug users was approximately £77 million per annum. After a median follow-up of 40 months, 10 patients (8%) had died. All deaths were attributable to drug use. Conclusions Bacterial and viral infections are largely responsible for the significant mortality and morbidity of injecting drug users presenting to secondary care. The financial burden to the NHS is substantial.

s 427 (2) or microscopically proven (1) actinomyces infection. All patients received IV ceftriaxone 4g daily and oral metronidazole 400mg three times daily (in all cases metronidazole was stopped after six weeks). Ceftriaxone was continued for 24 weeks in one patient (16 weeks via OHPAT), 28 weeks in a second patient (20 weeks via OHPAT) and a third patient currently continues on ceftriaxone, having completed eight weeks to date (six weeks via OHPAT). All patients were taught to self-administer their antibiotics via a PICC or Hickman Line, attending the outpatient department once a week only following hospital discharge for medical review. Results: The first two patients made complete clinical, radiological and functional recovery. At the time of writing (March 2008), the third patient had clinically and functionally recovered, with radiological improvement on interval CT brain at eight weeks on continuing therapy. Conclusions: Once-daily parenteral ceftriaxone administered via an OHPAT service can be successfully used to treat selected patients with actinomyces CNS infection. This may reduce hospital duration of stay, costs, and duration of treatment, and facilitate the early rehabilitation needed for a good functional outcome. AUDIT OF STAPHYLOCOCUS AUREUS BACTERAEMIA (SAB) IN A LONDON NHS TRUST Anna Pryce, Anand Sivaramakrishnan, Stephen MorrisJones University College Hospitals NHS Trust, London, United Kingdom