Bacterial Infections Associated With Substance Use Disorders, Large Cohort of United States Hospitals, 2012–2017

Abstract

Background Rises in the incidence of bacterial infections, such as infective endocarditis (IE), have been reported in conjunction with the opioid crisis. However, recent trends for IE and other serious infections among persons with substance use disorders (SUDs) are unknown. Methods Using the Premier Healthcare Database, we identified hospitalizations from 2012 through 2017 among adults with primary discharge diagnoses of bacterial infections and secondary SUD diagnoses, using International Classification of Diseases, Clinical Modification Ninth and Tenth Revision codes. We calculated annual rates of infections with SUD diagnoses and evaluated temporal trends. Blood and cardiac tissue specimens were identified from IE hospitalizations to describe the microbiology distribution and temporal trends among hospitalizations with and without SUDs. Results Among 72 481 weighted IE admissions recorded, SUD diagnoses increased from 19.9% in 2012 to 39.4% in 2017 (P < .0001). Hospitalizations with SUDs increased from 1.1 to 2.1 per 100 000 persons for IE, 1.4 to 2.4 per 100 000 persons for osteomyelitis, 0.5 to 0.9 per 100 000 persons for central nervous system abscesses, and 24.4 to 32.9 per 100 000 persons for skin and soft tissue infections. For adults aged 18–44 years, IE-SUD hospitalizations more than doubled, from 1.6 in 2012 to 3.6 in 2017 per 100 000 persons. Among all IE-SUD hospitalizations, 50.3% had a Staphylococcus aureus infection, compared with 19.4% of IE hospitalizations without SUDs. Conclusions Rates of hospitalization for serious infections among persons with SUDs are increasing, driven primarily by younger age groups. The differences in the microbiology of IE hospitalizations suggest that SUDs are changing the epidemiology of these infections.

Use of ICD-10 Codes for Identification of Injection Drug Use–Associated Infective Endocarditis Is Nonspecific and Obscures Critical Findings on Impact of Medications for Opioid Use Disorder

“…For example, there is no specific ICD-10 diagnosis code for IDU-IE. Prior work using administrative data to evaluate outcomes for IDU-IE rely on combinations of ICD codes for both endocarditis and opioid use disorders [ 3 , 4 , 7–9 ]. However, these codes include nonspecific conditions.…”

Predictors of skin and soft tissue infections among sample of rural residents who inject drugs

“…Hospitalizations to treat IDU-related SSTIs have risen in conjunction with increasing incidence of such infections [18]. Younger populations are at increased risk of hospitalization due to IDU-related infections [18], Nenninger et al [21].…”

“…Hospitalizations to treat IDU-related SSTIs have risen in conjunction with increasing incidence of such infections [18]. Younger populations are at increased risk of hospitalization due to IDU-related infections [18], Nenninger et al [21]. Between 1998 and 2001 in the USA, Takahashi et al [31] estimated that there were 106,126 hospitalizations for IDU-related SSTIs, costing an estimated $193 million annually, and these patients were often uninsured or covered by publicly funded insurance programs, such as Medicare or Medicaid [31].…”

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

“…Hospitalizations to treat IDU-related SSTIs have risen in conjunction with increasing incidence of such infections. Younger populations are at increased risk for hospitalization due to IDU-related infections (20,21). Between 1998 and 2001 in the United States, Takahashi et al estimated that there were 106,126 hospitalizations for IDU-related SSTIs, costing an estimated $193 million annually.…”