Consequently, most participants reported needing multiple injection attempts per injection episode (MIPIE) in order to achieve a successful injection. Participants without a prior history of hospitalization from injection-related bacterial infections reported anecdotal experiences of SBI from fellow injection drug users. Skin and soft tissue infections are a common complication of injecting recreational drugs.
Psychiatric disease as well as intravenous drug use are known risk factors for patients leaving the hospital against medical advice and for not adhering to treatment protocols [15]. These interviews reveal a robust and accurate knowledge base regarding skin infections, including the progression from simple cellulitis to an abscess, and acknowledgment of the possibility of serious infections. Nonetheless, there remains a reticence to seek care secondary to past traumatic experiences. A step-wise approach to self-care of SSTI infections was identified, which included themes of whole-body health, topical applications, use of non-prescribed antibiotics, and incision and drainage by non-medical providers. Harm reduction knowledge and psychosocial vulnerabilities influence drug use and high-risk drug injection practices.
Table 4
Studies in which BsAbs are used for an extensive period of time, as maintenance treatment, will reveal the long-term infection profile, which will be important to evaluate and aid development of long-term management guidelines. Patients with invasive fungal infections, such as invasive candidiasis or Aspergillosis should be treated per standard infectious diseases guidelines [71], preferably in consultation with an infectious diseases provider. We recommend temporarily discontinuing BsAb treatment during anti-fungal treatment, until symptom resolution (level III). General anti-bacterial prophylaxis is not recommended in patients receiving BsAbs (level III). However, we recommend use of anti-bacterial prophylaxis for patients with prolonged neutropenia (level IIC).
Our proposed Ecosocial understanding of SBI risk adds to pre-existing social-ecological models of drug-related harms by proposing pathways to tissue damage and ultimate development of SBI. Based on our results we suggest an Ecosocial understanding of SBI risk (Fig. 1). As such, SBI risk is the result of a multi-level interplay between individuals and their social and physical environments in producing risk for negative health outcomes.
Description of an abscess
A second limitation is that detailed information about the duration of drug addiction in patients was missing in most cases. Therefore, we were not able to substantiate the impression that the risk for hospitalization due to infections increased with the number of years of iv drug use addiction. Nevertheless, the age of our study population is rather high (median 38 years, mean 37 years) in comparison with the mean age of IVDU in a Swiss heroin maintenance program (mean 20.2–27 years, depending on the addictive drug that was being used, 2001) [44].
- If CMV infection risk is suspected, baseline quantification and monitoring of CMV DNA copies are recommended (level IIC).
- Injection drug use has traditionally been considered to be a risk factor for CA-MRSA skin infection, and several studies have demonstrated this association.8,9 We were therefore somewhat surprised to find that S.
- Patients with psychiatric diseases are known to have a limited capacity to consent to proposed interventions and are consequently more likely to refuse treatment [14].
- By not administering anesthetic and not enough of what they did, and then just grinding away at you in a way that was very unprofessional.
- Therefore, there may be a perception among health care workers that IVDU will be less willing to consent to or follow a specific antibiotic therapy.
This study does have some limitations and is primarily exploratory and hypothesis generating. First, this is a secondary analysis of qualitative data obtained for a separate, but related study. Ideally, the authors would have conducted subsequent interviews, further exploring the specific topic of interest and reaching saturation in these communities. Future investigations should purposively seek the perspectives of people of all genders, races, and ethnicities. The study was also limited to two metropolitan areas, and while they are distinct from one another, they do not represent all communities of PWID. Particularly in nuanced topics like this, more geographic diversity would benefit the generalizability of the findings.
How do clinical features vary in differing types of skin?
Skin and soft tissue infections (SSTI) along with bone and joint infections represent a significant source of morbidity and mortality among people who inject drugs (PWID). Participants reported a basic understanding of prevention of blood-borne viral transmission but limited understanding of SBI risk. Participants described engagement in high risk injection behaviors prior to hospitalization with SBI. These practices included polysubstance use, repetitive tissue damage, nonsterile drug diluting water and multipurpose use of water container, lack of hand and skin hygiene, re-use of injection equipment, network sharing, and structural factors leading to an unstable drug injection environment. Qualitative analysis led to the proposal of an Ecosocial understanding of SBI risk, detailing the multi-level interplay between individuals and their social and physical environments in producing risk for negative health outcomes.
- If further confirmation is required, use imaging, such as CT or PET-CT scans for pneumonia evaluation, suspected colitis, diverticulitis or abdominal abscesses, or procedural biopsy based on the infection site.
- Among this population, skin and soft tissue infections (SSTIs), including cellulitis and abscesses, are the most common reasons for hospitalizations [2, 8, 22], and rates of opioid-related SSTIs are increasing in the US, up to 9 per 100,000 in 2010 [3, 5, 23].
- All authors contributed to the survey results, and/or interpretation of data and critical review of the manuscript.
- Hence, younger patients were underrepresented in hospitalized IVDU in our study.
- Similar to studies prior to the emergence of CA-MRSA,2,10 we also found that Streptococcus anginosus, other viridans group streptococci, and anaerobic organisms were more common among injection drug users.
- Because little blood clots still plug up the hole and by wiggling you get them to move out of the way so that the little guy will go through and open the hole up, and the bigger stuff will come out, and then everything drains out.
Second, medical records do not always specify the route of drug administration; records indicating that the patient used drugs but did not document injection were excluded, which also might underestimate the number of persons injecting. Finally, the method of identifying infections could bias the distribution of pathogens or infection types. Infections with other pathogens or without a pathogen identified were identified by diagnostic codes only, and therefore were more likely to be missed. However, evidence suggests that most infections were identified through diagnostic codes. Aureus, Candida spp., and GAS infections identified by culture, 74% had codes for both an infection syndrome and substance use. The source of our data was restricted to hospital medical records and the detailed records of the specialists in the infectious diseases department.