[Acute injection-induced injuries in drug addicts. A review of 146 consecutive admissions]

Admissions of drug abusers with acute soft tissue lesions at the injection site increased in number over the period 1985-1989. There were 146 admissions in 90 patients. The diagnoses were: 58 superficial abscesses, 27 deep abscesses, 57 cellulitis, one tenosynovitis, one purulent arthritis, one not further categorised abscess and one case of arterial spasm. The commonest location was the groin (25%). Serious complications occurred in 17 cases, including four femoral amputations due to arterial lesions. Ultrasonic examination is recommended before surgery if central vessels can be involved, especially in the groin. Sufficient microbiological examination was performed in 78 cases. There was a predominance of polybacterial infections (53% polybacterial, 38% monobacterial, 9% sterile). The most common bacteria were Streptococcus spp. with a preponderance of oropharyngeal bacteria, Staphylococcus aureus, and anaerobes, especially Bacteroides spp. Typical intestinal bacteria were rare. We recommend that aerobic and anaerobic culturing with susceptibility testing always be carried out, that primary antibacterial therapy should be with an antistaphylococcal agent like dicloxacillin plus metronidazole and that free injection paraphernalia with disinfection swabs should be made easily available.