Infectious diseases, comorbidities and outcomes in hospitalized people who inject drugs (PWID)

Abstract

Injection drug use poses a public health challenge. Clinical experience indicates that people who inject drugs (PWID) are hospitalized frequently for infectious diseases, but little is known about outcomes when admitted. Charts were identified from local hospitals between 2013–2018 using consultation lists and hospital record searches. Included individuals injected drugs in the past six months and presented with infection. Charts were accessed using the hospital information system, undergoing primary and secondary reviews using Research Electronic Data Capture (REDCap). The Wilcoxon rank-sum test was used for comparisons between outcome categories. Categorical data were summarized as count and frequency, and compared using Fisher’s exact test. Of 240 individuals, 33% were admitted to the intensive care unit, 36% underwent surgery, 12% left against medical advice (AMA), and 9% died. Infectious diagnoses included bacteremia (31%), abscess (29%), endocarditis (29%), cellulitis (20%), sepsis (10%), osteomyelitis (9%), septic arthritis (8%), pneumonia (7%), discitis (2%), meningitis/encephalitis (2%), or other (7%). Sixty-six percent had stable housing and 60% had a family physician. Fifty-four percent of patient-initiated discharges were seen in the emergency department within 30 days and 29% were readmitted. PWID are at risk for infections. Understanding their healthcare trajectory is essential to improve their care.

Analysis of Patients’ Characteristics and Treatment Profile of People Who Use Drugs (PWUDs) with and without a Co-Diagnosis of Viral Hepatitis C: A Real-World Retrospective Italian Analysis

“…This finding is in line with the current literature, reporting that PWUDs, especially those with HCV diagnosis, are frequently hospitalized. 28,29 These results should be interpreted taking some limitations into account, above all lying in its observational design and the unavoidable flaws of the use of data retrieved from administrative databases. In fact, this approach might lead to a potential underestimation of clinical information on comorbidities and/or concomitant treatments that cannot be extrapolated from the database (also because underreported by patients) together with other potential confounding factors that might have affected the results.…”

Assessment of Bacterial Infections and Antibiotic Regimens in Intravenous Drug Users

“…The comorbid cardiac conditions associated with severe bacterial infection among IVDUs are hypertension, thrombosis (deep vein thrombosis, pulmonary embolism), congestive heart failure, and valvular conditions [ 9 ]. S. aureus is the most common bacterial infection leading to infective endocarditis [ 26 ].…”

“…Prolonged immobilization among IVDUs due to impairment in consciousness increases the risk of DVT and pressure ulcers, leading to infections [ 27 ]. Underlying local and distant site tissue damage helps create a favorable environment for the adherence and proliferation of bacteria [ 9 ]. The valvular conditions with damaged valves or prosthetic valves are prone to infections with Staphylococcus epidermidis , viridans streptococci, and Streptococcus bovis due to turbulence-mediated endothelial damage [ 9 ].…”

Preliminary Efficacy of a Theory-Informed Intervention to Increase COVID-19 Testing Uptake Among People Who Inject Drugs in San Diego County: Findings From a Pilot Randomized Controlled Trial

“…A national U.S. study identified nearly nine times the risk of COVID-19 diagnosis among patients with substance use disorders (SUD) compared to those without SUD [ 2 ]. Among people who inject drugs (PWID), multilevel factors elevate the risk of SARS-CoV-2 infection, hospitalization, and death, including chronic and infectious disease comorbidities [ 2 , 3 ], stigma, and other structural factors (e.g., homelessness, poverty, limited transportation, and health insurance) that reduce utilization of preventive screening and healthcare services [ 4 , 5 ].…”