Incidence and Treatment Costs of Severe Bacterial Infections Among People Who Inject Heroin: A Cohort Study in South London, England

Overview

Journal Drug Alcohol Depend

Publisher Elsevier

Specialty Psychiatry

Date 2020 May 19

PMID 32422537

Citations 9

Authors

Dan Lewer

Vivian D Hope

Magdalena Harris

Michael Kelleher

Amelia Jewell

Megan Pritchard

John Strang

Katherine I Morley

Affiliations

Soon will be listed here.

Abstract

Background: People who inject drugs often get bacterial infections. Few longitudinal studies have reported the incidence and treatment costs of these infections.

Methods: For a cohort of 2335 people who inject heroin entering treatment for drug dependence between 2006 and 2017 in London, England, we reported the rates of hospitalisation or death with primary causes of cutaneous abscess, cellulitis, phlebitis, septicaemia, osteomyelitis, septic arthritis, endocarditis, or necrotising fasciitis. We compared these rates to the general population. We also used NHS reference costs to calculate the cost of admissions.

Results: During a median of 8.0 years of follow-up, 24 % of patients (570/2335) had a severe bacterial infection, most commonly presenting with cutaneous abscesses or cellulitis. Bacterial infections accounted for 13 % of all hospital admissions. The rate was 73 per 1000 person-years (95 % CI 69-77); 50 times the general population, and the rate remained high throughout follow-up. The rate of severe bacterial infections for women was 1.50 (95 % CI 1.32-1.69) times the rate for men. The mean cost per admission was £4980, and we estimate that the annual cost of hospital treatment for people who inject heroin in London is £4.5 million.

Conclusions: People who inject heroin have extreme and long-term risk of severe bacterial infections.

Citing Articles

Epidemiology of acute infections in people who inject drugs in Australia.

Attwood L, OKeefe D, Higgs P, Vujovic O, Doyle J, Stewardson A Drug Alcohol Rev. 2023; 43(1):304-314.

PMID: 37995135 PMC: 10952783. DOI: 10.1111/dar.13772.

Prevalence and incidence of emergency department presentations and hospital separations with injecting-related infections in a longitudinal cohort of people who inject drugs.

Curtis S, Colledge-Frisby S, Stewardson A, Doyle J, Higgs P, Maher L Epidemiol Infect. 2023; 151:e192.

PMID: 37953739 PMC: 10728979. DOI: 10.1017/S0950268823001784.

Epidemiology and Management of invasive infections among people who Use drugs (EMU): protocol for a prospective, multicentre cohort study.

Attwood L, Bryant M, Lee S, Vujovic O, Higgs P, Doyle J BMJ Open. 2023; 13(4):e070236.

PMID: 37012020 PMC: 10083776. DOI: 10.1136/bmjopen-2022-070236.

Opioid Injection-Associated Bacterial Infections in England, 2002-2021: A Time Series Analysis of Seasonal Variation and the Impact of Coronavirus Disease 2019.

Lewer D, Brothers T, Croxford S, Desai M, Emanuel E, Harris M Clin Infect Dis. 2023; 77(3):338-345.

PMID: 36916065 PMC: 10425189. DOI: 10.1093/cid/ciad144.

Acute injection-related infections requiring hospitalisation among people who inject drugs: Clinical features, microbiology and management.

Langham F, Curtis S, Tang M, Jomon B, Doyle J, Vujovic O Drug Alcohol Rev. 2022; 41(7):1543-1553.

PMID: 36053863 PMC: 9804300. DOI: 10.1111/dar.13525.

References

Lewer D, Harris M, Hope V . Opiate Injection-Associated Skin, Soft Tissue, and Vascular Infections, England, UK, 1997-2016. Emerg Infect Dis. 2017; 23(8):1400-1403. PMC: 5547794. DOI: 10.3201/eid2308.170439. View

Lloyd-Smith E, Wood E, Zhang R, Tyndall M, Sheps S, Montaner J . Determinants of hospitalization for a cutaneous injection-related infection among injection drug users: a cohort study. BMC Public Health. 2010; 10:327. PMC: 2890691. DOI: 10.1186/1471-2458-10-327. View

Monteiro J, Phillips K, Herman D, Stewart C, Keosaian J, Anderson B . Self-treatment of skin infections by people who inject drugs. Drug Alcohol Depend. 2019; 206:107695. DOI: 10.1016/j.drugalcdep.2019.107695. View

Reeve R, Arora S, Butler K, Viney R, Burns L, Goodall S . Evaluating the Impact of Hospital Based Drug and Alcohol Consultation Liaison Services. J Subst Abuse Treat. 2016; 68:36-45. DOI: 10.1016/j.jsat.2016.05.008. View

Marks M, Pollock E, Armstrong M, Morris-Jones S, Kidd M, Gothard P . Needles and the damage done: reasons for admission and financial costs associated with injecting drug use in a Central London Teaching Hospital. J Infect. 2012; 66(1):95-102. DOI: 10.1016/j.jinf.2012.10.004. View

Leibler J, Liebschutz J, Keosaian J, Stewart C, Monteiro J, Woodruff A . Homelessness, Personal Hygiene, and MRSA Nasal Colonization among Persons Who Inject Drugs. J Urban Health. 2019; 96(5):734-740. PMC: 6814663. DOI: 10.1007/s11524-019-00379-9. View

Summers P, Hellman J, MacLean M, Rees V, Wilkes M . Negative experiences of pain and withdrawal create barriers to abscess care for people who inject heroin. A mixed methods analysis. Drug Alcohol Depend. 2018; 190:200-208. DOI: 10.1016/j.drugalcdep.2018.06.010. View

Phillips K, Anderson B, Herman D, Liebschutz J, Stein M . Risk Factors Associated With Skin and Soft Tissue Infections Among Hospitalized People Who Inject Drugs. J Addict Med. 2017; 11(6):461-467. PMC: 5659886. DOI: 10.1097/ADM.0000000000000346. View

Doherty M, Garfein R, Monterroso E, Brown D, Vlahov D . Correlates of HIV infection among young adult short-term injection drug users. AIDS. 2000; 14(6):717-26. DOI: 10.1097/00002030-200004140-00011. View

10.

Pinkham S, Stoicescu C, Myers B . Developing effective health interventions for women who inject drugs: key areas and recommendations for program development and policy. Adv Prev Med. 2012; 2012:269123. PMC: 3501794. DOI: 10.1155/2012/269123. View

11.

Marsden J, Eastwood B, Bradbury C, Dale-Perera A, Farrell M, Hammond P . Effectiveness of community treatments for heroin and crack cocaine addiction in England: a prospective, in-treatment cohort study. Lancet. 2009; 374(9697):1262-70. DOI: 10.1016/S0140-6736(09)61420-3. View

12.

Tracy D, Hahn J, Lewis C, Evans J, Briceno A, Morris M . Higher risk of incident hepatitis C virus among young women who inject drugs compared with young men in association with sexual relationships: a prospective analysis from the UFO Study cohort. BMJ Open. 2014; 4(5):e004988. PMC: 4039809. DOI: 10.1136/bmjopen-2014-004988. View

13.

Iversen J, Page K, Madden A, Maher L . HIV, HCV, and Health-Related Harms Among Women Who Inject Drugs: Implications for Prevention and Treatment. J Acquir Immune Defic Syndr. 2015; 69 Suppl 2:S176-81. PMC: 4505917. DOI: 10.1097/QAI.0000000000000659. View

14.

Small W, Rhodes T, Wood E, Kerr T . Public injection settings in Vancouver: physical environment, social context and risk. Int J Drug Policy. 2007; 18(1):27-36. DOI: 10.1016/j.drugpo.2006.11.019. View

15.

Perera G, Broadbent M, Callard F, Chang C, Downs J, Dutta R . Cohort profile of the South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLaM BRC) Case Register: current status and recent enhancement of an Electronic Mental Health Record-derived data resource. BMJ Open. 2016; 6(3):e008721. PMC: 4785292. DOI: 10.1136/bmjopen-2015-008721. View

16.

Degenhardt L, Charlson F, Stanaway J, Larney S, Alexander L, Hickman M . Estimating the burden of disease attributable to injecting drug use as a risk factor for HIV, hepatitis C, and hepatitis B: findings from the Global Burden of Disease Study 2013. Lancet Infect Dis. 2016; 16(12):1385-1398. DOI: 10.1016/S1473-3099(16)30325-5. View

17.

Dunleavy K, Munro A, Roy K, Hutchinson S, Palmateer N, Knox T . Association between harm reduction intervention uptake and skin and soft tissue infections among people who inject drugs. Drug Alcohol Depend. 2017; 174:91-97. DOI: 10.1016/j.drugalcdep.2017.01.020. View

18.

Dahlman D, Berge J, Bjorkman P, Nilsson A, Hakansson A . Both localized and systemic bacterial infections are predicted by injection drug use: A prospective follow-up study in Swedish criminal justice clients. PLoS One. 2018; 13(5):e0196944. PMC: 5979029. DOI: 10.1371/journal.pone.0196944. View

19.

Trayner K, Weir A, McAuley A, Godbole G, Amar C, Grant K . A pragmatic harm reduction approach to manage a large outbreak of wound botulism in people who inject drugs, Scotland 2015. Harm Reduct J. 2018; 15(1):36. PMC: 6042261. DOI: 10.1186/s12954-018-0243-9. View

20.

Larney S, Peacock A, Mathers B, Hickman M, Degenhardt L . A systematic review of injecting-related injury and disease among people who inject drugs. Drug Alcohol Depend. 2016; 171:39-49. DOI: 10.1016/j.drugalcdep.2016.11.029. View