Staphylococcus aureus bacteraemia associated with injected new psychoactive substances.

Area of Science:

• Infectious Diseases
• Public Health
• Toxicology

Background:

• Injecting drug use is a known risk factor for deep-seated infections.
• An increase in new psychoactive substances (NPS) injection has been observed in Lothian, Scotland.
• Patients injecting NPS have presented with severe Staphylococcus aureus bacteraemia (SAB).

Purpose of the Study:

• To describe a case series of SAB in patients who inject NPS.
• To compare the incidence of specific complications between NPS injectors and opiate injectors.
• To assess the impact of NPS-related SAB on regional public health targets.

Main Methods:

• Case series analysis of 14 episodes of SAB in ten patients.
• Comparison of complication rates (endocarditis, pulmonary lesions) between NPS and opiate injectors.
• Analysis of SAB incidence trends in relation to NPS use.

Main Results:

• NPS users showed a significantly higher incidence of endocarditis and cavitating pulmonary lesions compared to opiate-only injectors (P < 0.05).
• SAB cases in NPS injectors significantly increased the overall SAB incidence in people who inject drugs (P < 0.05).
• This rise has affected Lothian's ability to meet national SAB reduction targets.

Conclusions:

• Injecting NPS is associated with a higher risk of severe complications, including endocarditis and pulmonary lesions.
• The rise in NPS-related SAB poses a significant public health challenge, impacting regional control efforts.
• Urgent attention is needed to address the health consequences of NPS injection.