Upper Extremity Infection Related to Intravenous Drug Use: Considering the True Cost of the COVID-19 Pandemic and Lockdown

Abstract

Background: The COVID-19 pandemic caused significant morbidity and mortality in people who inject drugs (PWID). Upper extremity soft tissue infections are frequently associated with intravenous drug use (IVDU) due to poor compliance with aseptic technique. In Canada, multiple safe injection sites providing clean injection supplies closed, leaving many PWID with no alternatives to inject safely. It was hypothesized that these closures will correspond with increased morbidity and mortality among PWID. The main objective of this study was to determine the effect of the COVID-19 pandemic on the incidence of upper extremity infections in PWID. Methods: This was a retrospective chart review study. The primary outcome of interest was the frequency of upper extremity infections in PWID. Data were filtered to include only those patients presenting to the emergency department between March to June of 2019 and 2020. Chi-squared analysis was used to compare the number of IVDU patients among patients with upper extremity skin infections between these time periods. Results: The number of IVDU patients treated for upper extremity infections in Hamilton significantly increased during the pandemic, relative risk = 2.0 (95% confidence interval [CI]: 1.3-2.9, P = .0012,) while total upper extremity infections numbers have decreased overall. During the pandemic, PWID made up a larger proportion of upper extremity infections ( χ2 = 10.444, P = .00123). Demographic data such as age and sex of IVDU patients presenting with upper extremity infection was not significantly affected by the pandemic. Conclusions: The effect of the pandemic on accessing harm reduction services has led to evident increases in morbidity as described by this study. Further research on the impact of closures in PWID is needed to quantify these harms and work toward mitigation strategies.

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

“…5 In keeping with this, several other Canadian studies found the average hospital stay for the PWID population to be greater than those without a history of substance use. 10,32 In the current study, 26% of all patient discharges from the hospital were patient-directed (against medical advice). Patient-directed discharge is three times more common in patients with substance use disorder compared to those without.…”

Emergence of Erythromycin-Resistant Invasive Group A Streptococcus, West Virginia, USA, 2020–2021

“…Recent studies have documented increases in drug use and overdose indicators during the COVID-19 pandemic, including higher rates of emergency department visits, emergency medical service dispatches, urine drug screen positivity, and death ( 47 , 48 ). Similarly, a study from Ontario, Canada, focusing on IVDU noted a 2-fold higher rate of IVDU-related SSTI than for the prepandemic era ( 49 ). At J.W.…”

“…Nationwide data from 2010-2017 identified emm92, emm49, and emm82 as predominant iGAS types among patients with a history of IVDU and in those experiencing homelessness ( 22), but 2020-2021 West Virginia data identified emm92, emm11, and emm89 as the top (47,48). Similarly, a study from Ontario, Canada, focusing on IVDU noted a 2-fold higher rate of IVDU-related SSTI than for the prepandemic era (49). At J.W.…”

A paradigm shift in the management of injectable drug use related upper extremity infections: Lessons learned during the COVID-19 pandemic

“…A Canadian group examined the frequency with which patients presented to their institution in a 3-month period before and during the pandemic. 4 The authors found that the total number of cases doubled during the pandemic. This study analyzed a Canadian hospital system and it didn’t evaluate management of the infection.…”

“… 3 Injectable drug use related infections (IDURIs) are associated with significant morbidity. 4 The aim of this study was to evaluate the differences in incidence and management of UE IDURIs in pre-pandemic and pandemic cohorts. We hypothesized that both the incidence and severity of IDURIs increased during the pandemic.…”