Bacterial Infections Associated With Substance Use Disorders, Large Cohort of United States Hospitals, 2012-2017

Abstract

Background: Rises in the incidence of bacterial infections, such as infective endocarditis (IE), have been reported in conjunction with the opioid crisis. However, recent trends for IE and other serious infections among persons with substance use disorders (SUDs) are unknown.

Methods: Using the Premier Healthcare Database, we identified hospitalizations from 2012 through 2017 among adults with primary discharge diagnoses of bacterial infections and secondary SUD diagnoses, using International Classification of Diseases, Clinical Modification Ninth and Tenth Revision codes. We calculated annual rates of infections with SUD diagnoses and evaluated temporal trends. Blood and cardiac tissue specimens were identified from IE hospitalizations to describe the microbiology distribution and temporal trends among hospitalizations with and without SUDs.

Results: Among 72 481 weighted IE admissions recorded, SUD diagnoses increased from 19.9% in 2012 to 39.4% in 2017 (P < .0001). Hospitalizations with SUDs increased from 1.1 to 2.1 per 100 000 persons for IE, 1.4 to 2.4 per 100 000 persons for osteomyelitis, 0.5 to 0.9 per 100 000 persons for central nervous system abscesses, and 24.4 to 32.9 per 100 000 persons for skin and soft tissue infections. For adults aged 18-44 years, IE-SUD hospitalizations more than doubled, from 1.6 in 2012 to 3.6 in 2017 per 100 000 persons. Among all IE-SUD hospitalizations, 50.3% had a Staphylococcus aureus infection, compared with 19.4% of IE hospitalizations without SUDs.

Conclusions: Rates of hospitalization for serious infections among persons with SUDs are increasing, driven primarily by younger age groups. The differences in the microbiology of IE hospitalizations suggest that SUDs are changing the epidemiology of these infections.

Keywords: bacterial infection; endocarditis; injection drug use; opioid; substance use.

Figure 1.

Weighted infective endocarditis hospitalizations with and without substance use disorder diagnoses, Premier Healthcare Database, 2012–2017. Includes opioids, cocaine, amphetamines, hallucinogens, or other/unspecified drugs (see Supplementary Materials). Abbreviations: IE-SUD, infective endocarditis hospitalization with substance use disorder diagnoses; IE-Non-SUD, infective endocarditis hospitalization without substance use disorder diagnoses.

Figure 2.

Trends of microorganisms among infective endocarditis hospitalizations with positive cultures, Premier Healthcare Database, 2012–2017 (N = 1826). Abbreviation: S. aureus, Staphylococcus aureus.