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

Abstract

Objectives Skin and soft tissue infections (SSTIs) are common among people who inject drugs (PWID) and can lead to serious morbidity and costly emergency room and hospital utilization. A range of high-risk injection practices may contribute to these infections. The goal of the current study was to examine risk practices that were associated with SSTIs in a sample of hospitalized PWID. Methods PWID (N = 143; 40.6% female) were recruited from inpatient medical units at a large urban hospital and completed a baseline interview that focused on infection risk. Measures included demographics, substances used/injected, and self-report of SSTIs (i.e., abscesses, ulcers, or cellulitis) within the last year. The Bacterial Infections Risk Scale for Injectors (BIRSI), a 7-item index, assessed specific behaviors expected to increase the risk of acquiring SSTIs (e.g., injection without skin cleaning, intramuscular injection). Results The sample was 58% Caucasian and averaged 38.7 (SD = 10.7) years of age. Ninety-three participants (65%) reported at least one SSTI within the last year. Using a logistic regression model, the BIRSI (OR = 1.87, p = .004) and total number of injections over the last three months (OR = 2.21, p = .002) were associated with past year SSTIs. Conclusions In conclusion, rates of last year SSTIs were high in this sample of hospitalized PWID. Results suggest that interventions should target specific injection practices to reduce infection risk.

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

“…Cultural norms among rural populations are also different than those in urban areas, potentially serving as additional factors lending to higher rates of SSTIs among females in comparison to males in rural settings. (8,12,15). Our ndings among PWID in rural areas are consistent with their urban peers, suggesting that both populations use higher-risk sites via either 'skin-popping' or 'muscling' for injection practices.…”

“…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).…”

The impact of the COVID-19 pandemic on harm reduction services in Spain

“…Early detection of COVID-19 could help mitigate possible complications caused by the virus among PWUD, who may have underlying chronic medical conditions that increase their risk of developing severe COVID-19 illness, such as COPD, asthma, cardiovascular diseases, and viral hepatitis [ 9 ]. PWUD are at risk for sepsis and endocarditis, and commonly have skin and soft tissue infections [ 34 , 35 ] which, when left untreated, can lead to hospitalisation and even amputation, putting them at greater risk if infected with COVID-19.…”

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 (Gray, Rogawaski McQuade, Scheld, & Dillingham, 2018) (Persons who inject drugs (PWID), 2018). 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 (Smith, Robinowitz, Chaulk, & Johnson, 2016) (Tuchman, 2015) (Dahlman, Hakansson, Bjorkman, Blome, & Kral, 2015) (Hope, Kimber, Vickerman, Hickman, & Ncube F, 2008) (Phillips, Anderson, Herman, Liebschutz, & Stein, 2017). Individuals recently experiencing homelessness are also more likely to report a history of SSTI, potentially relating to injecting in unsafe or unsanitary environments (Dahlman, Hakansson, Bjorkman, Blome, & Kral, 2015) (Hope, Kimber, Vickerman, Hickman, & Ncube F, 2008) (Phillips, Anderson, Herman, Liebschutz, & Stein, 2017).…”

“…Behavioral factors, such as high risk injection practices, are commonly associated with SSTIs among PWID (Phillips, Anderson, Herman, Liebschutz, & Stein, 2017) (Galea & Vlahov, 2002). Using and sharing contaminated single-use syringes, needles, and ancillary equipment places individuals at higher risk for spreading infectious agents; prior HIV and HCV outbreaks throughout the United States have been closely associated with the sharing of such equipment (Persons who inject drugs (PWID), 2018) (Hope, Kimber, Vickerman, Hickman, & Ncube F, 2008) (Page, Morris, Hahn, Maher, & Prins, 2013) (Galea & Vlahov, 2002).…”