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BMC Public Health
Published in: BMC Public Health 1/2010

Open Access 01-12-2010 | Research article

Determinants of hospitalization for a cutaneous injection-related infection among injection drug users: a cohort study

Authors: Elisa Lloyd-Smith, Evan Wood, Ruth Zhang, Mark W Tyndall, Sam Sheps, Julio SG Montaner, Thomas Kerr

Published in: BMC Public Health | Issue 1/2010

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Astract

Background

Cutaneous injection-related infections (CIRI) are a primary reason individuals who inject drugs (IDU) are hospitalized. The objective of this study was to investigate determinants of hospitalization for a CIRI or related infectious complication among a cohort of supervised injection facility (SIF) users.

Methods

From 1 January 1 2004 until 31 January 2008, using Cox proportional hazard regression, we examined determinants of hospitalization for a CIRI or related infectious complication (based on ICD 10 codes) among 1083 IDU recruited from within the SIF. Length of stay in hospital and cost estimates, based on a fully-allocated costing model, was also evaluated.

Results

Among hospital admissions, 49% were due to a CIRI or related infectious complication. The incidence density for hospitalization for a CIRI or related infectious complication was 6.07 per 100 person-years (95% confidence intervals [CI]: 4.96 - 7.36). In the adjusted Cox proportional hazard model, being HIV positive (adjusted hazard ratio [AHR] = 1.79 [95% CI: 1.17 - 2.76]) and being referred to the hospital by a nurse at the SIF (AHR = 5.49 [95% CI: 3.48 - 8.67]) were associated with increased hospitalization. Length of stay in hospital was significantly shorter among participants referred to the hospital by a nurse at the SIF when compared to those who were not referred (4 days [interquartile range {IQR}: 2-7] versus 12 days [IQR: 5-33]) even after adjustment for confounders (p = 0.001).

Conclusions

A strong predictor of hospitalization for a CIRI or related infectious complication was being referred to the hospital by a nurse from the SIF. This finding indicates that nurses not only facilitate hospital utilization but may provide early intervention that prevents lengthy and expensive hospital visits for a CIRI or related infectious complication.
Literature
1.
Palepu A, Tyndall MW, Leon H, Muller J, O'Shaughnessy MV, Schechter MT, et al: Hospital utilization and costs in a cohort of injection drug users. CMAJ. 2001, 165: 415-420.PubMedPubMedCentral
2.
Murphy E, DeVita D, Liu H, Vittinghoff E, Leung P, Ciccarone DH, et al: Risk factors for skin and soft-tissue abscesses among injection drug users: a case-control study. Clin Infect Dis. 2001, 33: 35-40. 10.1086/320879.CrossRefPubMed
3.
Ciccarone D, Bamberger JD, Kral AH, Edlin BR, Hobart CJ, Moon A, et al: Soft tissue infections among injection drug users - San Francisco, California, 1996-2000. MMWR Morb Mortal Wkly Rep. 2001, 50: 381-384.
4.
Takahashi TA, Baernstein A, Binswanger I, Bradley K, Merrill JO: Predictors of hospitalization for injection drug users seeking care for soft tissue infections. J Gen Intern Med. 2007, 22: 382-388. 10.1007/s11606-006-0079-y.CrossRefPubMedPubMedCentral
5.
Hope V, Kimber J, Vickerman P, Hickman M, Ncube F: Frequency, factors and costs associated with injection site infections: findings from a national multi-site survey of injecting drug users in England. BMC Infect Dis. 2008, 8: 10.1186/1471-2334-8-120.
6.
DiNubile MJ, Lipsky BA: Complicated infections of the skin and skin structures: when the infection is more than skin deep. J Antimicrob Chemother. 2004, 53: ii37-ii50. 10.1093/jac/dkh202.CrossRefPubMed
7.
Kak V, Chandrasekar PH: Bone and joint infections in injection drug users. Infect Dis Clin North Am. 2002, 16: 681-695. 10.1016/S0891-5520(02)00016-8.CrossRefPubMed
8.
Gordon RJ, Lowy FD: Bacterial infections in drug users. N Engl J Med. 2005, 353: 1945-1954. 10.1056/NEJMra042823.CrossRefPubMed
9.
del Giudice P: Cutaneous complications of intravenous drug abuse. Br J Dermatol. 2004, 150: 1-10. 10.1111/j.1365-2133.2004.05607.x.CrossRefPubMed
10.
DiNubile MJ: Short-course antibiotic therapy for right-sided endocarditis caused by Staphylococcus aureus in injection drug users. Ann Intern Med. 1994, 121: 873-876.CrossRefPubMed
11.
Ngaage DL, Cowen ME: Right ventricular needle embolus in an injecting drug user: the need for early removal. Emerg Med J. 2001, 18: 500-501. 10.1136/emj.18.6.500.CrossRefPubMedPubMedCentral
12.
Ebright JR, Pieper B: Skin and soft tissue infections in injection drug users. Infect Dis Clin North Am. 2002, 16: 697-712. 10.1016/S0891-5520(02)00017-X.CrossRefPubMed
13.
Schulz S, Beckenbach C, Philipp M, Hengstmann J: Color coded duplex sonography of inguinal vessels in i.v. drug addicts. Vasa. 2002, 31: 7-13. 10.1024/0301-1526.31.1.7.CrossRefPubMed
14.
Roszler MH, McCarroll KA, Donovan KR, Rashid T, Kling GA: The groin hit: complications of intravenous drug abuse. Radiographics. 1989, 9: 487-508.CrossRefPubMed
15.
Wood E, Kerr T, Small W, Palepu A, Tyndall MW: Changes in public order after the opening of a medically supervised safer injecting facility for illicit injection drug users. CMAJ. 2004, 169: 759-763.
16.
Kerr T, Tyndall M, Li K, Montaner J, Wood E: Safer injection facility use and syringe sharing in injection drug users. Lancet. 2005, 366: 316-318. 10.1016/S0140-6736(05)66475-6.CrossRefPubMed
17.
Milloy MJS, Kerr T, Tyndall M, Montaner J, Wood E: Estimated drug overdose deaths averted by North America's first medically-supervised safer injection facility. PLoS ONE. 2008, 3: e3351-10.1371/journal.pone.0003351.CrossRefPubMedPubMedCentral
18.
Milloy MJS, Kerr T, Mathias R, Zhang R, Montaner J, Tyndall M, Wood E: Non-fatal overdose among a cohort of active injection drug users recruited from a supervised injection facility. Am J Drug Alcohol Abuse. 2008, 34: 499-509. 10.1080/00952990802122457.CrossRefPubMed
19.
Wood E, Tyndall MW, Zhang R, Stoltz JA, Montaner J, Kerr T: Attendance at supervised injection facilities and use of detoxification services. N Engl J Med. 2006, 354: 2512-2514. 10.1056/NEJMc052939.CrossRefPubMed
20.
Lloyd-Smith E, Wood E, Zhang R, Tyndall M, Montaner J, Kerr T: Risk factors for developing a cutaneous injection-related infection among injection drug users: a cohort study. BMC Public Health. 2008, 8: 405-10.1186/1471-2458-8-405.CrossRefPubMedPubMedCentral
21.
Wood E, Kerr T, Lloyd-Smith E, Buchner C, Marsh D, Montaner J, Tyndall MW: Methodology for evaluating Insite: Canada's first medically supervised safer injection facility for injection drug users. Harm Reduct J. 2004, 1-
22.
Organisation for Economic Co-operation and Development (OECD) Health data 2007. 2007
23.
Corneil TA, Kuyper LM, Shoveller J, Hogg RS, Li K, Spittal P, Schechter M, Wood E: Unstable housing, associated risk behaviour, and increased risk for HIV infection among injection drug users. Health Place. 2006, 12: 79-85. 10.1016/j.healthplace.2004.10.004.CrossRefPubMed
24.
Brettle RP: Bacterial infections in HIV: the extent and nature of the problem. Int J STD AIDS. 1997, 5: 5-15. 10.1258/0956462971918698.CrossRef
25.
Stein MD, Sobota M: Injection drug use: hospital care and charges. Drug Alcohol Depend. 2001, 64: 117-120. 10.1016/S0376-8716(00)00235-0.CrossRefPubMed
26.
Spijkerman IJ, van Ameijden EJ, Mientjes GH, Coutinho RA, van den Hoek A: Human immunodeficiency virus infection and other risk factors for skin abscesses and endocarditis among injection drug users. J Clin Epidemiol. 1996, 49: 1149-1154. 10.1016/0895-4356(96)00180-1.CrossRefPubMed
27.
Palepu A, Strathdee SA, Hogg RS, Anis AH, Rae S, Cornelisse PG, Patrick DM, O'Shaughnessy MV, Schechter MT: The social determinants of emergency department and hospital use by injection drug users in Canada. J Urban Health. 1999, 76: 409-418. 10.1007/BF02351499.CrossRefPubMedPubMedCentral
28.
Small W, Wood E, Lloyd-Smith E, Tyndall M, Kerr T: Accessing care for injection-related infections through a medically supervised injecting facility: a qualitative study. Drug Alcohol Depend. 2008, 98: 159-162. 10.1016/j.drugalcdep.2008.05.014.CrossRefPubMed
29.
Harris HW, Young DM: Care of injection drug users with soft tissue infections in San Francisco, California. Arch Surg. 2002, 137: 1217-1222. 10.1001/archsurg.137.11.1217.CrossRefPubMed
30.
Grau LE, Arevalo S, Catchpool C, Heimer R: Expanding harm reduction services through a wound and abscess clinic. Am J Public Health. 2002, 92: 1915-1917. 10.2105/AJPH.92.12.1915.CrossRefPubMedPubMedCentral
31.
Kerr T, Wood E, Grafstein E, Ishida T, Shannon K, Lai C, Montaner JM, Tyndall MW: High rates of primary care and emergency department use among injection drug users in Vancouver. J Public Health. 2005, 27: 62-66. 10.1093/pubmed/fdh189.CrossRef
32.
Darke S: Self-report among injecting drug users: a review. Drug Alcohol Depend. 1998, 51: 253-263. 10.1016/S0376-8716(98)00028-3.CrossRefPubMed
33.
Binswanger IA, Takahashi TA, Bradley K, Dellit TH, Benton KL, Merrill JO: Drug users seeking emergency care for soft tissue infection at high risk for subsequent hospitalization and death. J Stud Alcohol Drugs. 2008, 69: 924-932.CrossRefPubMedPubMedCentral
Metadata
Title
Determinants of hospitalization for a cutaneous injection-related infection among injection drug users: a cohort study
Authors
Elisa Lloyd-Smith
Evan Wood
Ruth Zhang
Mark W Tyndall
Sam Sheps
Julio SG Montaner
Thomas Kerr
Publication date
01-12-2010
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2010
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-10-327

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