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. 2020 Jul 1:212:108057.
doi: 10.1016/j.drugalcdep.2020.108057. Epub 2020 May 6.

Incidence and treatment costs of severe bacterial infections among people who inject heroin: A cohort study in South London, England

Dan Lewer  1 , Vivian D Hope  2 , Magdalena Harris  3 , Michael Kelleher  4 , Amelia Jewell  4 , Megan Pritchard  4 , John Strang  5 , Katherine I Morley  6
Affiliations

Incidence and treatment costs of severe bacterial infections among people who inject heroin: A cohort study in South London, England

Dan Lewer et al. Drug Alcohol Depend. .

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.

Keywords: Bacterial infections; Drug injection; Heroin; Opiates.

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Conflict of interest statement

Declaration of Competing Interest MK is employed by the South London and Maudsley NHS Trust (SLaM) as clinical lead for Lambeth Addictions Consortium, which provides treatment for the patients included in this study. JS is a clinician and researcher and has worked extensively on clinical trials and wider research. JS’s employer (King’s College London) receives, unconnected to this specific study but connected to his wider work, project grant support and/or honoraria and/or consultancy payments from government agencies, charitable sources and also from pharmaceutical companies related to funding for clinical trials and research studies (for fuller information see www.kcl.ac.uk/ioppn/depts/addictions/people/hod.aspx).

Figures

Fig. 1
Fig. 1
Rate of hospital admission for severe bacterial infection in a cohort of 2335 people who inject heroin in South London, England, by time after first treatment episode (error bars show 95% confidence intervals).
Fig. 2
Fig. 2
Rate of hospital admission for severe bacterial infection in a cohort of 2335 people who inject heroin, by primary diagnosis. (error bars show 95% confidence intervals).
See this image and copyright information in PMC

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