Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 May 2;19(1):41.
doi: 10.1186/s12954-022-00624-6.

Severe bacterial infections in people who inject drugs: the role of injection-related tissue damage

Alexander Hrycko  1 , Pedro Mateu-Gelabert  2 , Courtney Ciervo  2 , Rebecca Linn-Walton  3 , Benjamin Eckhardt  4
Affiliations

Severe bacterial infections in people who inject drugs: the role of injection-related tissue damage

Alexander Hrycko et al. Harm Reduct J. .

Abstract

Background: In the context of the current U.S. injection drug use epidemic, targeted public health harm reduction strategies have traditionally focused on overdose prevention and reducing transmission of blood-borne viral infections. Severe bacterial infections (SBI) associated with intravenous drug use have been increasing in frequency in the U.S. over the last decade. This qualitative study aims to identify the risk factors associated with SBI in hospitalized individuals with recent injection drug use.

Methods: Qualitative analysis (n = 15) was performed using an in-depth, semi-structured interview of participants admitted to Bellevue Hospital, NYC, with SBI and recent history of injection drug use. Participants were identified through a referral from either the Infectious Diseases or Addition Medicine consultative services. Interviews were transcribed, descriptively coded, and analyzed for key themes.

Results: Participants reported a basic understanding of prevention of blood-borne viral transmission but limited understanding of SBI risk. Participants described engagement in high risk injection behaviors prior to hospitalization with SBI. These practices included polysubstance use, repetitive tissue damage, nonsterile drug diluting water and multipurpose use of water container, lack of hand and skin hygiene, re-use of injection equipment, network sharing, and structural factors leading to an unstable drug injection environment. Qualitative analysis led to the proposal of an Ecosocial understanding of SBI risk, detailing the multi-level interplay between individuals and their social and physical environments in producing risk for negative health outcomes.

Conclusions: Structural factors and injection drug use networks directly impact drug use, injection drug use practices, and harm reduction knowledge, ultimately resulting in tissue damage and inoculation of bacteria into the host and subsequent development of SBI. Effective healthcare and community prevention efforts targeted toward reducing risk of bacterial infections could prevent long-term hospitalizations, decrease health care expenditures, and reduce morbidity and mortality.

Keywords: Injection drug use; Risk factors; Severe bacterial infection; Tissue damage.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Socio-ecological model—multilevel risk factor associated with SBI
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Hope VD, Ncube F, Parry JV, Hickman M. Healthcare seeking and hospital admissions by people who inject drugs in response to symptoms of injection site infections or injuries in three urban areas of England. Epidemiol Infect. 2015;143(1):120–131. doi: 10.1017/S0950268814000284. - DOI - PMC - PubMed
    1. Gordon R, Lowy F. Bacterial infections in drug users. N Engl J Med. 2005;353:1945–1954. doi: 10.1056/NEJMra042823. - DOI - PubMed
    1. Hope V. Neglected infections, real harms: a global scoping of injection-related bacterial infections and responses. In: Harm Reduction International. 2010; p. 89–95.
    1. Gray ME, Rogawski McQuade ET, Scheld WM, Dillingham RA. Rising rates of injection drug use associated infective endocarditis in Virginia with missed opportunities for addiction treatment referral: a retrospective cohort study. BMC Infect Dis. 2018;18(1):1–9. doi: 10.1186/s12879-017-2892-9. - DOI - PMC - PubMed
    1. Wurcel AG, Anderson JE, Chui KKH, Skinner S, Knox TA, Snydman DR, et al. Increasing infectious endocarditis admissions among young people who inject drugs. Open Forum Infect Dis. 2016;3(3). - PMC - PubMed

Publication types