High Rates of Abscesses and Chronic Wounds in Community-Recruited Injection Drug Users and Associated Risk Factors

Abstract

Objectives Abscesses and chronic wounds are common among injection drug users (IDUs) though chronic wounds have been understudied. We assess the risk factors associated with both acute and chronic wounds within a community-based population of IDUs frequenting the Baltimore City Needle Exchange Program (BNEP). Methods We performed a cross-sectional study of BNEP clients ≥18 years who completed an in-person survey regarding active or prior wounds including abscesses (duration <8 weeks) and chronic wounds (duration ≥8 weeks), injection practices, and skin care. Factors associated with wounds were analyzed using univariate and multivariate logistic regression. Results Of the 152 participants, 63.2% were men, 49.3% were Caucasian, 44.7% were African American, 34.9% had any type of current wound, 17.8% had an active abscess, and 19.7% had a current chronic wound. Abscesses were more common in women (odds ratio [OR], 2.56; 95% confidence interval [CI], 1.10–5.97); and those reporting skin-popping (OR, 5.38; 95% CI, 1.85–15.67). In a multivariate model, risk factors for an abscess included injecting with a family member/partner (AOR, 4.06; 95% CI, 0.99–16.58). In a multivariable analysis of current chronic wounds, cleaning skin with alcohol prior to injection was protective (AOR, 0.061; 95% CI, 0.0064–0.58). Conclusions Abscesses and chronic wounds were prevalent among a sample of IDUs in Baltimore. Abscesses were associated with injection practices, and chronic wounds appeared linked to varying skin and tool cleaning practices. There is a pressing need for wound-related education and treatment efforts among IDUs who are at greatest risk for skin-related morbidity.

Risk Factors Associated With Skin and Soft Tissue Infections Among Hospitalized People Who Inject Drugs

“…The BIRSI assesses a range of behavioral risk factors for acquiring SSTIs and was developed to capture some of the most common factors reported in the literature on SSTIs among PWID, such as injecting without skin cleaning, using used needles, and injecting intramuscularly (Binswanger et al, 2000; Gordon & Lowy, 2005; Murphy et al, 2001; Phillips & Stein, 2010; Smith et al, 2015). If confirmed in a prospective study, the BIRSI index may represent a new brief instrument for predicting risk of SSTIs, a major contributor to the morbidity of PWID.…”

“…Among these, SSTIs are common, with almost 70% of injectors reporting past SSTIs and 12–35% reporting current or recent infections (Binswanger et al, 2000; Dahlman et al, 2015; Hope et al, 2008; Morrison et al, 1997; Phillips & Stein, 2010; Smith et al, 2015). Skin infection is one of the most common reasons that PWID present to the emergency department (ED) or are admitted for inpatient hospitalization (Marks et al, 2013; Ciccarone et al, 2001; Palepu et al, 2001).…”

“…Demographic variables, such as female gender and unstable housing, have been shown to be associated with current and lifetime SSTIs (Dahlman et al, 2015; Hope et al, 2008; Lloyd-Smith et al, 2005, 2008). Women describe more problems finding veins and may be at greater risk for infections due to a range of sociocultural factors that lead to depending on others for injecting, which often involves sharing injection equipment (Darke et al, 2001; Kral et al, 1999; Smith et al, 2015; Tuchman, 2015). HIV-positive status has been examined in a range of studies, focusing on reduced immune function leading to increased bacterial infection susceptibility (Brettle, 1997; Flanigan et al, 1999; Gebo et al, 2006; Lloyd-Smith et al, 2005; Wilson et al, 2002).…”

“…Early data demonstrating that the skin flora of PWID contributes significantly to bacterial infections (Tuazon et al, 1974) has been followed by studies suggesting that skin cleaning with alcohol at the injection site reduces the odds of SSTIs (Murphy et al, 2001; Smith et al, 2015; Vlahov et al, 1992). Hand washing appears protective against skin abscesses and other injecting-related injuries and diseases (Dwyer et al, 2009).…”

Predictors of Skin and Soft Tissue Infections Among Sample of Rural Residents Who Inject Drugs

“…Infections associated with IDU disproportionately affect non-Hispanic white Americans experiencing economic distress and populations living in rural and suburban areas (1,3). Sociocultural factors surrounding injection drug use place females at a higher risk for developing SSTIs, such as relying on other individuals to prepare their drug; increased potential for shared injection equipment; and greater di culty nding veins (8)(9)(10)(11)(12). Individuals recently experiencing homelessness are also more likely to report a history of SSTI, potentially relating to injecting in unsafe or unsanitary environments (10)(11)(12).…”