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

Abstract

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.