Background Injection drug use-associated endocarditis (IDUaIE) incidence in Ontario has recently been associated with hydromorphone prescribing rates. Staphylococcus aureus causes the majority of cases of IDUaIE in Ontario and across North America. Hydromorphone controlled-release (Hydromorphone-CR) requires a complex technique for injection and therefore provides multiple opportunities for contamination. Hydromorphone-CR contains several excipients, which could enhance staphylococcal survival and increase risk of contaminating the injectate. Methods Used injection drug preparation equipment (cookers/filters) was collected from persons who inject drugs (PWID), rinsed with water, and plated on Mannitol salt agar. Bacterial isolates from bacteremic PWID were used to assess the survival of S . aureus and Streptococcus pyogenes on cookers/filters with Hydromorphone-CR, hydromorphone immediate-release (Hydromorphone-IR) or oxycodone controlled-release (Oxycodone-CR). The solutions spiked with S . aureus were heated and the remaining viable bacteria enumerated. Results S . aureus was detected in 12/87 (14%, 95%CI 8–23%) cookers/filters samples used for injection of Hydromorphone-CR. Hydromorphone-CR was the only opioid associated with greater survival of methicillin-sensitive S . aureus (MSSA) and methicillin-resistant S . aureus (MRSA) on cookers/filters when compared to sterile water vehicle control. There was a ~2 log reduction in the number of S . aureus that survived when cookers/filters were heated. Conclusion 14% of all cookers/filters used in the preparation of Hydromorphone-CR were contaminated with S . aureus . Hydromorphone-CR prolongs the survival of MRSA and MSSA in cookers/filters. Heating cookers/filters may be a harm-reduction strategy.

Clinical decision-making may be directly impacted by wearable application. Some people think that wearable technologies, such as patient rehabilitation outside of hospitals, could boost patient care quality while lowering costs. The big data produced by wearable technology presents researchers with both a challenge and an opportunity to expand the use of artificial intelligence (AI) techniques on these data. By establishing new healthcare service systems, it is possible to organise diverse information and communications technologies into service linkages. This includes emerging smart systems, cloud computing, social networks, and enhanced sensing and data analysis techniques. The characteristics and features of big data, the significance of big data analytics in the healthcare industry, and a discussion of the effectiveness of several machine learning algorithms employed in big data analytics served as our conclusion.

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Background S. aureus is the most common pathogen associated with injection drug use-associated endocarditis (IDUaIE). Our center has a high incidence of IDUaIE and the opiate of choice in our population is hydromorphone-controlled release (HCR), a prescribed oral opiate widely used in Canada and Europe. The complex technique for preparation for injection provides multiple opportunities for contamination of the solution and the controlled-release preparation contains several excipients (carbohydrates, protein, and iron), which could enhance Staphylococcal survival. A large amount of drug remains in the injection drug preparation equipment (IDPE) after each use and therefore, used IDPE is saved by people who inject drugs (PWID) for subsequent reuse by adding more water and then injecting the solution intravenously.MethodsUsed IDPE was collected from active PWID, rinsed with sterile water, aspirated into a syringe in a technique which mimicked reuse of equipment by PWID, and then plated on Mannitol salt agar (MSA). Bacterial isolates from local bacteremic PWID were used to test the survival of S. aureus (MRSA and MSSA) and S. pyogenes on unused IDPE with HCR or hydromorphone immediate release (HIR). The solutions were aspirated using techniques similar to that of local PWID and then plated on MSA and Blood agar.ResultsA total of 109 used IDPE samples were collected between March 2017 and March 2018. S. aureus was detected in 15/94 (16%) IDPE samples that had been used for injection of HMC (seven MRSA, seven MSSA, and two borderline resistant [one sample contained both MRSA and MSSA]), but 0/15 (0%) samples used for hydromorphone immediate release (HIR). HCR, but not HM, was associated with greater survival of MSSA and MRSA (but not S. pyogenes) in solutions of the drug when compared with sterile water vehicle control (Figure 1). There was a 2-log reduction in the number of viable S. aureus when IDPE containing HCR solutions spiked with MRSA or MSSA were heated with a cigarette lighter until bubbling (<10 seconds).ConclusionIDPE that has been used in the preparation of HCR is frequently contaminated with S. aureus; and in vitro HCR, but not HM, prolongs the survival of MRSA and MSSA. Heating IDPE may be an effective harm-reduction strategy to reduce bacterial complications of injection of HCR. Disclosures All authors: No reported disclosures.