Risk Practices Associated with Bacterial Infections among Injection Drug Users in Denver, Colorado

Abstract

Background There has been limited research on bacterial infections (e.g., skin and soft tissue abscesses, endocarditis) among injection drug users (IDUs), despite these infections often resulting in serious morbidity and costly medical care. Although high-risk practices that contribute to bacterial infections are not entirely clear, certain injection practices have been found to increase risk in past studies. Objectives To examine rates of bacterial infections among IDUs in Denver, CO and high-risk practices that predict skin infections. Methods Structured interviews were conducted with 51 active heroin, cocaine and methamphetamine IDUs (over 18 years). Results Among all participants, 55% reported a lifetime history of at least one skin infection and 29% reported having an infection in the last year. Those with a skin infection in the last year were significantly more likely to inject intramuscularly (OR = 1.57) and to report greater heroin injection frequency (OR = 1.08) compared to IDUs with no history of skin infections. Heroin and speedball injectors reported a higher number of past abscesses compared to methamphetamine and cocaine injectors. Conclusion Intervention strategies to reduce bacterial infections should focus on high-risk injection practices. Scientific Significance Learning about rates of bacterial infections and high-risk practices associated with these infections can benefit researchers developing risk reduction interventions for IDUs.

Abscess infections and malnutrition – a cross-sectional study of polydrug addicts in Oslo, Norway

“…The frequency of abscess infections in the present sample was comparable to the 29% frequency reported for injection drug users in Colorado, USA in 2010 [5]. Injection frequency, puncture site and the prevalence of other infections, such as hepatitis C and…”

“…A higher infectious rate also increases nutritional needs, and insufficient dietary intakes promote malnutrition and co-morbidities, suppress immune function and diminish response to therapies [5].…”

“…Injection of drugs is common [3] and frequently causes bacterial infections as abscesses, that may result in serious morbidity and costly medical care [4,5]. The occurrence of abscess infections has been related to hepatitis infections, HIV/AIDS, intramuscular injections and the reuse and sharing of syringes, female gender, recent imprisonment, involvement in the sex trade and frequent cocaine use [6,7].…”

Abscess and Self-Treatment Among Injection Drug Users at Four California Syringe Exchanges and Their Surrounding Communities

“…For instance, in San Francisco, California, a study found that 54 (32%) of 169 IDUs in one neighborhood had current abscesses, cellulitis, or both during a physical examination (Binswanger, Kral, Bluthenthal, Rybold, & Edlin, 2000). In Vancouver, Canada, and Tijuana, Mexico, studies reported that ~20% of IDUs had an abscess in the prior 6 months (Lloyd-Smith et al, 2005; Pollini et al, 2010); in Denver, Colorado, 29% of IDUs reported an abscess in the prior year (Phillips & Stein, 2010). Abscesses can be very painful and prompt treatment, mostly with antibotics, may succeed in avoiding more costly and invasive surgical incision and drainage of abscess wounds.…”

Importance of Dermatology in Infective Endocarditis

“…Nevertheless, intravenous drug users are more at risk (10% of IE) due to poor hygiene. Indeed 55% of active heroin, cocaine and methamphetamine injection drug users report a lifetime history of skin infection mainly in cases of intramuscular injection or frequent heroin or speedball injection (Phillips, 2010). In these cases, S. aureus and fungi must be suspected and treated.…”