Recurrent Polymicrobial Pathogens From Licking Syringe Plungers: A Case Report and Artificial-intelligence-augmented Scoping Review of Oropharyngeal Bacterial Infections Linked to Unsafe Injection Practices.

Abstract

<h4>Objectives</h4>People who inject drugs are at an increased risk of infectious complications. Certain injection practices can lead to bacterial complications from oral flora, including licking needles or using saliva to clean the skin. We report the first case in the literature of a patient licking the syringe plunger and present a scoping review to identify other injection practices associated with oropharyngeal bacterial complications from injecting drugs.<h4>Methods</h4>The authors searched OVID Medline, Embase, and APA PsycINFO to identify case reports and case series of patients with infections related to salivary contamination in the injection process. Studies with suspected unsafe injection practices based on the pathogen, but with no specific injection practices reported, were excluded. Artificial intelligence (AI) was utilized to augment the traditional scoping review by refining search criteria for a repeated traditional search and conducting iterative AI literature searches using embedded links.<h4>Results</h4>Nine sources were identified with AI-augmented embedded article searching that were not identified in the traditional scoping review. One source was identified with AI-augmented search criteria. If only the traditional scoping review had been used, 3 of the 13 articles would have been identified.<h4>Conclusions</h4>The scoping review identified unexpected etiologies of oropharyngeal bacterial contamination, not limited to licking needles, illustrating the importance of gaining an in-depth, step-by-step understanding of how each patient with intravenous drug use injects to identify potential modes of infection. This case also provides an example of potential advancements in artificial intelligence to augment research by improving search strategies, such as MeSH terms and identifying articles.