Community-acquired skin and soft-tissue infections in people who inject drugs

Abstract

Purpose of reviewThe aim of this review is to discuss the latest evidence of the epidemiology, microbiology, risk factors, diagnosis and management of community-acquired skin and soft tissue infections (SSTIs) in people who inject drug (PWID). Recent findingsSSTIs are common complications in PWID and a major cause of morbidity and mortality. Infections can range from uncomplicated cellulitis, to abscesses, deep tissue necrosis and necrotizing fasciitis. They are predominantly caused by Gram-positive pathogens in particular Staphylococcus aureus and Streptococcus species; however, toxin-producing organisms such as Clostridium botulism or Clostridium tetani should be considered. The pathogenesis of SSTI in the setting of intravenous drug use (IDU) is different from non-IDU related SSTI, and management often requires surgical interventions in addition to adjunctive antibiotics. Harm reduction strategies and education about safe practices should be implemented to prevent morbidity and mortality as well as healthcare burden of SSTI in PWID. SummaryPrompt diagnosis and proper medical and surgical management of SSTI will improve outcomes in PWID.

Injecting drug use and hepatitis C virus infection independently increase biomarkers of inflammatory disease risk which are incompletely restored by curative direct-acting antiviral therapy

“…Injury and infection related to injection site and injection practices can result from contaminated injecting equipment and/or the introduction of pathogens, foreign bodies and skin contaminants during the process of injecting ( 25 , 27 , 51 ). Over 60% of PWID report a history of skin and soft tissue infections with subcutaneous/intradermal injecting practices and vascular damage associated with injecting contributing to this risk ( 26 ). Injection frequency and duration correlate positively with markers of immune activation including d-dimer and sCD14 ( 39 ), whilst methamphetamine users with HIV who injected the drug exhibited elevated levels of numerous inflammatory biomarkers (including IL-6, sTNF-RI and sCD163) compared to those who did not inject ( 52 ).…”

Advancements in Dermatological Applications of Curcumin: Clinical Efficacy and Mechanistic Insights in the Management of Skin Disorders

“…82,83 While community-acquired infections are predominantly due to methicillin-resistant Staphylococcus aureus (MRSA) and beta-hemolytic streptococcus, the microbial landscape is broadening, partly due to factors like diabetes, immune dysfunction, and environmental exposure. [84][85][86] Diagnosis relies on clinical assessment, with laboratory tests supporting uncertain cases or deep infection evaluations. Initial antimicrobial treatment is empirical, tailored to cover staphylococci and streptococci for simple infections, or a broader spectrum for complicated cases necessitating hospitalization and possibly surgical intervention.…”

Necrotizing fasciitis: an update on epidemiology, diagnostic methods, and treatment

“…These include chronic kidney disease (CKD), diabetes mellitus, liver cirrhosis, alcoholism, valvular heart disease, and stroke, with CKD and liver cirrhosis being significant predictors of in-hospital mortality [11]. Nowadays, with the increasing prevalence of intravenous drug use, NF among people who inject drugs is being recognized as a distinct clinical entity characterized by a unique pathogenesis, microbiology, and necessitates a different treatment approach [12 ▪ ].…”