Factors Associated With Severe Bacterial Infections in People Who Inject Drugs: A Single-center Observational Study

Area of Science:

• Infectious Diseases
• Public Health
• Addiction Medicine

Background:

• People who inject drugs (PWID) have elevated risks for serious bacterial infections, including bacteremia, endocarditis, and osteomyelitis.
• These infections lead to significant morbidity, high healthcare costs, and limited understanding of associated drug injection practices.

Purpose of the Study:

• To investigate demographic and behavioral factors linked to severe bacterial infections in individuals who inject drugs.
• To identify specific injection drug use practices contributing to infection risk.

Main Methods:

• A survey was conducted with individuals admitted to a New York City hospital for severe bacterial infections between August 2020 and June 2021.
• The survey examined demographic data and detailed injection drug use behaviors.

Main Results:

• Thirty-four participants with injection drug use-associated severe bacterial infections were recruited; 56% were treated for infective endocarditis.
• Participants reported high rates of daily injection (82%), frequent multiple attempts per injection (50%), and syringe reuse (94%).
• Prolonged hospital stays (mean 32.2 days) and suboptimal treatment completion for opioid use disorder were observed.

Conclusions:

• Severe bacterial infections in PWID result in complex, lengthy hospitalizations with poor outcomes.
• Identified nonsterile injection practices underscore a gap in current harm reduction and infection prevention efforts.
• Enhanced messaging and interventions are needed to address risky behaviors and reduce infection rates.