Intravenous Drug Use-Related Complications of the Hand and Upper Extremity

In the last decade, there has been an increase in intravenous drug use (IVDU) and associated medical problems. Users commonly inject into their upper extremities, which can result in infection and other sequelae in this area. The goal of this study was to compare demographics and treatment for upper extremity infections between intravenous drug users and non-intravenous drug users over the past 10 years at 1 level I emergency department (ED).

This was a retrospective case-control study. All patients presenting to the ED with an upper extremity infection in 2005, 2010, and 2015 were identified using the ninth revision of the International Statistical Classification of Diseases and Related Health Problems and Current Procedural Terminology codes. Patients with an IVDU-related infection were identified by manually reviewing the medical record and matched with patients with non-IVDU-related infection on demographics. Patient-related factors, infection specifics, and treatment parameters were compared in both groups.

The number of IVDU-related upper extremity infection cases presenting to the ED increased 126% over the 10-year period (65 cases in 2005, 109 cases in 2010, and 147 cases in 2015). The location of infection in the IVDU group was more likely to be in a typical injection site (forearm, P < 0.001; wrist, P = 0.002), and IVDU patients had 33% more hospital admissions and stayed in the hospital longer (3 days versus 0.59; P < 0.001). These patients also were more likely to have a computed tomography scan (P < 0.001) and have Methicillin-resistant Staphylococcus aureus (MRSA) or Methicillin-sensitive Staphylococcus aureus (MSSA) (P = 0.009).

Over a 10-year period, the number of IVDU-related upper extremity infections more than doubled, with more severe infections that underwent advanced imaging and intensive treatment.