Staphylococcus aureus Infections in Injection Drug Users: Risk Factors and Prevention Strategies

Abstract

Infections, in particular soft tissue infections (cellulitis, skin abscesses), are the leading cause for emergency department visits and hospital admissions of drug injection users (IDUs). Staphylococcus aureus is the most relevant bacterial pathogen in this population. It is the main cause of soft tissue infections and of severe infections such as endocarditis and bacteremia. Moreover, epidemic spread of methicillin-resistant S. aureus (MRSA) among IDUs has occurred in Europe and North America. Nasal carriage of S. aureus is associated with an increased risk of subsequent S. aureus infections, and it has been shown that active IDUs have a higher rate of colonization with S. aureus than the general population. However, it is still unknown why an individual carries S. aureus. In particular, repeated injections do not appear to be the main predisposing factor for S. aureus carriage. Infections associated with injection drug use are frequently the consequence of the illegal status of street drugs. Harm reduction programs, including needle exchange programs, safer injecting facilities and injection opiate substitution programs can reduce the incidence of infections among severely addicted IDUs.

Tricuspid Valve Endocarditis with Septic Pulmonary Emboli in a Drug Addict

“…Additionally, others demonstrated a high infestation rate of methicillin-resistant Staphylococcus aureus (MRSA) in IVDA. 8) However, uncomplicated tricuspid valve endocarditis can be successfully, medically treated in 80% of patients; in the remaining 20% with very large vegetations and expectably poor antibiotic penetration like in the presented case, surgical treatment is required with an appropriate postoperative course of culture-directed antibiotics, although IVDA run the high risk of reinfection. 5,9) Because of this, patients presenting with right-sided endocarditis should receive an antibiotic treatment spanning Staphylococcus aureus, streptococci, and enterococci and should include penicillinase-resistant penicillins or vancomycin, depending on the local prevalence of MRSA.…”

Outbreak in Alberta of community-acquired (USA300) methicillin-resistant Staphylococcus aureus in people with a history of drug use, homelessness or incarceration

“…Given that 71% of the patients whose cases met our inclusion criteria reported use of cocaine or crack cocaine, transmission may also be increased by the more frequent use of these drugs, drug use in settings such as crack houses, or sharing contaminated drugs or drug paraphernalia (e.g., needles, crack pipes). 23,27,28 Although none of 7 cultures that we did on 2 samples of crack cocaine seized by police in Calgary grew CA-MRSA, 4 of 12 crack pipes that we tested had results positive for methicillin-sensitive S. aureus, which suggests that pipes may be a potential vector.…”

Methicillin-Resistant Staphylococcus aureus Nasal Carriage among Injection Drug Users: Six Years Later

“…People who misuse drugs have a higher rate of nasal or skin colonization with S. aureus than the general population (2,14). Furthermore, S. aureus nasal carriage has been found to be associated with an increased risk of subsequent infections in IDUs (2).…”