Epidemiology of upper limb skin and soft tissue infections requiring surgical intervention in Saskatoon, Canada: A retrospective chart review

Abstract

Background: Skin and soft tissue infections (SSTIs) are a leading cause of hospital admission and engagement with the health care system amongst people who inject drugs (PWID). The current study aims to describe the epidemiology of SSTIs requiring surgical intervention in Saskatoon, Canada. Methods: This retrospective chart review assessed patients with a primary diagnosis of upper limb SSTIs requiring surgical intervention at St. Paul’s Hospital and Royal University Hospital (Saskatoon, Canada) between January 1 and December 31, 2020. Results: 38 eligible patients with a median age of 34 years and M:F of 21:17 were identified. 31 (81.6%) smoked cigarettes and 19 (50.0%) used intravenous drugs. A majority of SSTIs were unilateral infections involving the hand 22 (57.9%) or upper arm 11 (28.9%). Ten (26.3%) patients had a prior SSTI requiring surgical management. Necrotizing fasciitis was diagnosed in 7 (18.4%) patients, two of which, required amputation of the affected hand or arm. The median length of hospital stay was 6 days (IQR: 4 – 14.5). Ten patients left the hospital against medical advice, before completion of treatment; of these patients, 8 (80.0%) were PWID. Conclusion: Harm reduction strategies may help address the rising incidence and recurrence of SSTIs in the injection drug use population. Involvement of addiction services and social work during hospital admission may reduce the rate of patient-directed discharge, facilitating the completion of treatment. Furthermore, increased access to needle exchange programs in the community may reduce the number of SSTIs caused by contaminated injection equipment in the PWID population.