Bacterial and Fungal Infections in Persons Who Inject Drugs — Western New York, 2017

Hartnett, Kathleen P.; Jackson, Kelly A.; Felsen, Christina B.; McDonald, Robert; Bardossy, Ana C.; Gokhale, Runa; Kracalik, Ian; Lucas, Todd; McGovern, Olivia L.; Beneden, Chris Van; Mendoza, Michael; Bohm, Michele K.; Brooks, John T.; Asher, Alice; Magill, Shelley S.; Fiore, Anthony E.; Blog, Debra; Dufort, Elizabeth; See, Isaac; Dumyati, Ghinwa

doi:10.15585/mmwr.mm6826a2

Cited by 41 publications

(37 citation statements)

References 10 publications

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“…Notably, heroin use is relatively uncommon in our community, and use of lemon juice is not seen (due to the major local type of heroin being white heroin, which does not require an acidifier, as well as vitamin C being routinely distributed in the local needle exchange program to prevent lemon juice use for heroin or crack cocaine) [34]. An increasing incidence of invasive candidiasis in PWID has also been recently reported in other North American centers [35, 36]. Previously reported mortality rates in fungal IE are around 50% despite aggressive combined medical and surgical intervention [29, 30, 32].…”

Section: Discussionmentioning

confidence: 99%

Recurrent Endocarditis in Persons Who Inject Drugs

Rodger

Shah

Shojaei

et al. 2019

Open Forum Infectious Diseases

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Background Infective endocarditis (IE) is increasing among persons who inject drugs (PWID) and has high morbidity and mortality. Recurrent IE in PWID is not well described. Methods This was a retrospective cohort study conducted between February 2007 and March 2016. It included adult inpatients (≥18) at any of 3 tertiary care centers in London, Ontario, with definite IE based on the Modified Duke's Criteria. The objectives were to characterize recurrent IE in PWID, identify risk factors for recurrent IE, identify the frequency of fungal endocarditis, and establish whether fungal infection was associated with higher mortality. Results Three hundred ninety patients had endocarditis, with 212/390 in PWID. Sixty-eight of 212 (32%) PWID had a second episode, with 28/212 (12%) having additional recurrences. Second-episode IE was more common in PWID (11/178 [6.2%] vs 68/212 [32.1%]; P < .001). Peripherally inserted central catheter (PICC) line abuse was associated with increased risk of recurrent endocarditis (odds ratio [OR], 1.97; 95% confidence interval [CI], 1.01–3.87; P = .04). In PWID, fungal IE was more common in second episodes than first episodes (1/212 [0.5%] vs 5/68 [7.4%]; P = .004). Additionally, fungal infections were associated with mortality in second-episode IE in PWID with an adjusted OR of 16.49 (95% CI, 1.12–243.17; P = .041). Despite recurrent infection, likely due to continued drug use, there was a low rate of referral to addiction treatment (14/68 [20.6%]). Conclusions PWID have a high risk of recurrent endocarditis, particularly in patients who abuse PICC lines. Fungal endocarditis is more common in second-episode endocarditis and is associated with increased mortality. Consideration of empiric antifungal therapy in PWID with IE history and suspected IE should be considered.

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Section: Discussionmentioning

confidence: 99%

Recurrent Endocarditis in Persons Who Inject Drugs

Rodger

Shah

Shojaei

et al. 2019

Open Forum Infectious Diseases

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“…High-risk injection practices, such as syringe sharing, have led to a secondary epidemic of infectious complications of drug use. This includes increasing IDU-associated infections from human immunodeficiency virus (HIV) [1,2] and hepatitis C virus [3], as well as increasing hospitalizations for skin and soft tissue infections (SSTIs), osteomyelitis, septic arthritis, and endocarditis [4][5][6][7][8][9]. Establishment of syringe services programs (SSPs) is a proven harm reduction strategy that reduces HIV and HCV transmission among persons who inject drugs (PWID) [10].…”

Section: Introductionmentioning

confidence: 99%

When is an abscess more than an abscess? Syringe services programs and the harm reduction safety-net: a case report

et al. 2020

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Background: Syringe services programs (SSPs) are able to offer wrap-around services for people who inject drugs (PWID) and improve health outcomes. Case presentation: A 47-year-old man screened positive for a skin and soft tissue infection (SSTI) at an SSP and was referred to a weekly on-site student-run wound care clinic. He was evaluated by first-and third-year medical students, and volunteer attending physicians determined that the infection was too severe to be managed on site. Students escorted the patient to the emergency department, where he was diagnosed with a methicillin-resistant Staphylococcus aureus arm abscess as well as acute HIV infection. Conclusion: Student-run wound care clinics at SSPs, in conjunction with ongoing harm reduction measures, screenings, and treatment services, provide a safety-net of care for PWID and help mitigate the harms of injection drug use.

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“…Rates of injection drug use (IDU) have grown in parallel with the national opioid epidemic since 2000 (1,2). IDU is a growing public health concern given the associated risk of the transmission of blood-borne diseases, such as Human Immunode ciency Virus (HIV), hepatitis C Virus (HCV), and of skin and soft tissue infections (SSTIs) (1,3).…”

Section: Introductionmentioning

confidence: 99%

“…Common IDU-related SSTIs include skin abscesses, cellulitis, osteomyelitis, and infective endocarditis (4). Bacteria found in skin ora, primarily Staphylococcus aureus, cause IDU-related SSTIs when they are introduced into the bloodstream during injection (2,5). People who inject drugs (PWID) have demonstrated higher rates of S. aureus colonization in skin ora than the general population, predisposing them to a greater risk of infection (5).…”

Section: Introductionmentioning

confidence: 99%

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

Baltes

Akhtar

Birstler

et al. 2020

Preprint

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Introduction: Skin and soft tissue infections (SSTIs) are among the leading causes of morbidity and mortality for people who inject drugs (PWID). Studies demonstrate that certain injection practices correlate with SSTI incidence among PWID. The opioid epidemic has particularly affected rural communities, where access to prevention and treatment presents unique challenges. This study aims to understand current injection practices and SSTI history among a rural-dwelling PWID.Methods: Thirteen questions specific to SSTIs and injection practices were added to a larger study assessing unmet health care needs among PWID and were administered at six needle exchange programs in rural Wisconsin between May and July 2019. SSTI history prevalence was estimated based on infections reported within one-year prior of response and was compared to self-reported demographics and injection practices. Results: Eighty responses were collected and analyzed. Respondents were white (77.5%), males (60%), between the ages 30-39 (42.5%), and have a high school diploma or GED (38.75%). Females were over three times more likely to report SSTI history (OR=3.07, p=0.038) compared to males. Water sources for drug dilution (p=0.093) and frequency of injecting on first attempt (p=0.037), but not proper skin cleaning method (p = 0.378), were significantly associated with a history of SSTI. Injecting into skin (p=0.038) or muscle (p=0.001) significantly associated with a history of SSTI whereas injection into veins did not (p=0.333).Conclusion: Higher-risk injection practices were common among participants reporting a history of SSTIs in this rural sample. Studies exploring socio-demographic factors influencing risky injection practices and general barriers to safer injection practices to prevent SSTIs are warranted. Dissemination of education materials targeting SSTI prevention and intervention among PWID not in treatment are warranted.

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Bacterial and Fungal Infections in Persons Who Inject Drugs — Western New York, 2017

Cited by 41 publications

References 10 publications

Recurrent Endocarditis in Persons Who Inject Drugs

Recurrent Endocarditis in Persons Who Inject Drugs

When is an abscess more than an abscess? Syringe services programs and the harm reduction safety-net: a case report

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

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