HIV Seropositivity Predicts Longer Duration of Stay and Rehospitalization Among Nonbacteremic Febrile Injection Drug Users With Skin and Soft Tissue Infections
Department of Emergency Medicine, The Johns Hopkins University, 5801 Smith Avenue, Suite 3220, Davis Building, Baltimore, MD 21209, USA. JAIDS Journal of Acquired Immune Deficiency Syndromes
(Impact Factor: 4.56).
12/2008; 49(4):398-405. DOI: 10.1097/QAI.0b013e318183ac84
Skin/soft tissue infections (SSTIs) are the leading cause of hospital admissions among injection drug users (IDUs).
We performed a retrospective investigation to determine the epidemiology of SSTIs (ie, cellulitis and/or abscesses) in febrile IDUs, with a focus on bacteriology and potential predictors of increased health care utilization measured by longer length of stay and rehospitalization. Subjects were drawn from a cohort of febrile IDUs presenting to an inner-city emergency department from 1998 to 2004.
Of the 295 febrile IDUs with SSTIs, specific discharge diagnoses were cellulitis only (n = 143, 48.5%), abscesses only (n = 113, 38.3%), and both (n = 39, 13.2%). Documented HIV infection rate was 28%. Of note, 10 subjects were newly diagnosed with HIV infection during their visits. Staphylococcus aureus was the leading pathogen, and increasing rates of methicillin-resistant S. aureus emerged over time (before 2001: 4%, 2001-2004: 56%, P < 0.01). HIV seropositivity predicted rehospitalization within 90 days [adjusted hazard ratios and 95% confidence intervals: 2.90 (1.20 to 7.02)]. HIV seropositivity also predicted increased length of stay in those who were nonbacteremic [adjusted hazard ratios and 95% confidence intervals: 1.49 (1.11 to 2.01)].
Among febrile IDUs with SSTIs, a strong association between HIV seropositivity and health care resource utilization was found. Accordingly, attention to HIV serostatus should be considered in clinical disposition decisions for this vulnerable high-risk population.
Available from: Kristina T Phillips
- "Although IDUs often attempt to self-treat when they contract an abscess (Binswanger et al., 2000; Roose, Hayashi, & Cunningham, 2009), abscesses can develop into lifethreatening infections that can lead to hospitalization requiring extensive intravenous antibiotics, the delivery of which is complicated in persons without adequate venous access. Greater numbers of methicillin-resistant S aureus and polymicrobial bacterial infections are being observed among IDUs (Al-Rawahi et al., 2008; Hsieh, Rothman, Bartlett, Yang, & Kelen, 2008; Lloyd-Smith et al, 2010). These infections tend to be more severe and difficult to treat (Siegel, Rhinehart, Jackson, Chiarello, & the Healthcare Infection Control Practices Advisory Committee, 2007). "
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ABSTRACT: A new skin and needle hygiene intervention, designed to reduce high-risk injection practices associated with bacterial and viral infections, was tested in a pilot, randomized controlled trial. Participants included 48 active heroin injectors recruited through street outreach and randomized to either a 2-session intervention or an assessment-only condition (AO) and followed up for 6 months. The primary outcome was skin- and needle-cleaning behavioral skills measured by videotaped demonstration. Secondary outcomes were high-risk injection practices, intramuscular injection, and bacterial infections. Intervention participants had greater improvements on the skin (d = 1.00) and needle-cleaning demonstrations (d = .52) and larger reductions in high-risk injection practices (d = .32) and intramuscular injection (d = .29), with a lower incidence rate of bacterial infections (hazard ratio = .80), at 6 months compared with AO. The new intervention appears feasible and promising as a brief intervention to reduce bacterial and viral risks associated with drug injection.
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