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Microbes Causing Spinal Epidural Infection in Patients Who Use Drugs.
Alexander Pralea1, Phinnara Has2, Dianne Auld3
1Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Open Forum Infectious Diseases
|October 17, 2024
Summary
Spine infections are rising due to the opioid crisis. People who inject drugs (PWUD) with spinal infections are more likely to have methicillin-resistant Staphylococcus aureus (MRSA) and gram-negative bacteria.
Area of Science:
- Infectious Diseases
- Public Health
- Microbiology
Background:
- The opioid epidemic has led to an increase in injection drug use and associated spine infections.
- Limited research exists on the specific microbiology of spinal epidural infections in people who inject drugs (PWUD) compared to the general population.
Purpose of the Study:
- To compare the microbiology of spinal epidural infections in patients with and without a history of substance use disorder.
- To identify specific pathogens associated with active injection drug use in spinal infections.
Main Methods:
- Retrospective chart review of patients diagnosed with spinal epidural abscess or phlegmon between 2015 and 2023.
- Categorization of patients into non-PWUD, nonactive PWUD, and active PWUD based on drug use history.
- Analysis of microbiologic data to identify causative organisms.
Main Results:
- 39% of patients with spinal epidural infections had a substance use disorder.
- Active PWUD showed a higher incidence of methicillin-resistant Staphylococcus aureus (MRSA) infections (36%) compared to non-PWUD (13%).
- Nonactive PWUD had a greater likelihood of gram-negative bacterial infections (excluding E. coli) than non-PWUD.
Conclusions:
- Over one-third of patients with non-surgical spinal epidural infections had substance use disorder.
- These patients face increased risk of infections caused by MRSA and specific gram-negative bacteria like Serratia marcescens.
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