Bone and joint infections in intravenous drug abusers

An analysis of data on 45 intravenous drug abusers treated for skeletal infection in 1982-1983 is presented. Eighty percent of patients were younger than 40 years old. None had any serious underlying illnesses. Septic arthritis was noted in 33 patients, osteomyelitis in seven, and both in five. Bone or joint infection involved the extremities in 78% of patients. The knee joint (left, 11 patients; right, four) was most commonly affected, and the left groin was the most frequent site of drug injections, a finding that suggests a relationship between the sites of injection and infection. Fever was absent in 16 (36%) of 45 patients. The predominant pathogens isolated were methicillin-resistant Staphylococcus aureus and groups A and G streptococci. Pseudomonas aeruginosa was much less common (11% of patients). Treatment included bed rest, intravenous antibiotics, and arthrocentesis when needed. Surgery was required in only seven (16%) of 45 patients. The immediate prognosis for intravenous drug abusers with skeletal infection was excellent. Attempts to obtain follow-up information from most patients, however, were unsuccessful.