Skin and Soft Tissue Infections

Participants reported using intravenous drugs while hospitalized and noted unsafe injection practices (e.g., needle re-use, using medically placed venous catheters) while doing so. Managing withdrawal symptoms in hospitalized PWID with SBI would ultimately decrease risky injection practices that may lead to severe complications, elopement or leaving the hospital against medical advice, as well as ensuring completion of treatment course [50]. Self-treatment of abscesses by PWID is common and may lead to the development of SBI.

Public Health

At this point, the iterative process was used to develop broader categories, which, through discussion, were expanded into larger, key themes. Through this iterative process of developing codes, categories, and themes, a Thematic Analysis approach was employed to develop the findings presented below [30]. As the interviews were performed during a single, limited time period, saturation was not specifically achieved through ongoing interviews. Participants reported occasional syringe sharing during instances of syringe shortages while injecting in the company of close network members where perceived HCV and HIV status was known.

Acute infections in intravenous drug users

• Superficial and small abscesses respond well to drainage and seldom require antibiotics.
• Contact your healthcare provider, especially if the symptoms include a fever or do not improve within 48 hours.Do not pick at or pop the bump or sore.
• An abscess is an infection of the surface skin, um, around an injection site.
• Women are at an increased risk as they may have more difficult venous access.
• The most common bloodborne pathogen identified§ was hepatitis C virus; 41 (37%) patients had a current or previous hepatitis C virus infection documented in the medical record; seven (6%) had a history of HIV infection, and four (4%) had hepatitis B virus infection.

Those challenging periods undermining PWID willingness to inject safely likely increased opportunities for bacterial introduction during the injection process. The above findings highlight the complexity of the injection drug use process and the potential social and physiological pathways leading to SBI. This study attempts to understand the multiple domains at the structural, network, and individual level that impact drug injection practices and provide context by which these factors predispose and lead to physiological tissue damage and the development of SBI among PWID.

Description of an abscess

Septic pulmonary emboli can seed from injection-site infections and tricuspid valve endocarditis and usually present with high fever and symptoms suggestive of pulmonary emboli.11 Lung abscesses result typically from aspiration, frequently due to K pneumoniae13 or septic emboli. Although chest X-ray is sufficient to demonstrate the pulmonary infection in most cases, CT can be useful to confirm cavitation and the distribution of infection and to exclude pulmonary embolus. This creates an opportunity for iv drug use partnership, empowerment, and knowledge exchange between PWID and the healthcare community. Harm reduction agencies and healthcare professionals should create open dialogs with PWID to learn from these communities and subsequently develop workshops and printed information to propagate this knowledge and address any misconceptions that may exist. One important conceptual deficit we identified was defining specifically when an SSTI has progressed to the point when it needs prompt medical intervention.

Early abscess self-care treatment

In addition, task shifting to peer health workers (PHW) is an ongoing debate in low-and-middle-income countries with insufficient medical staffing. In addition to expanding capacity, PHWs can also bridge the cultural gap between the patient and the provider. This occurs because the peer health workers are fluent in the vernacular of their patients, they are the patient’s first point of contact, easing them into the difficult to navigate norms of health care setting, and can educate the health care provider on providing culturally appropriate care to the patient [18]. Peer health workers are another resource that should be considered in addressing the disparities in care for PWID.

Localized SSTI as a result of injection practices was a recurring theme and perceived to be manageable without seeking medical attention. Perceptions regarding risk, anecdotal experience with self-treatment, as well as physical factors including one’s addiction may explain reluctance to seek medical care. Additionally, prior negative experiences within the context of inadequate opioid withdrawal management may also lead to reluctance to seek medical treatment [46,47,48]. In our sample of PWID, there is accurate working knowledge of the stages of SSTI pathophysiology and treatment options. Despite appreciating the potential severity of this illness, the reticence to pursue formal care due to previous firsthand or secondhand negative health care experiences is ubiquitous and concerning.

IDU: infections, wounds, and other implications

Socioeconomically disadvantaged participants frequently reported difficulties finding sterile water to use as a drug diluent and would often use discarded or re-used bottles as a source of water, increasing the risk of oral flora contamination of these water sources. Failure to adequately perform skin hygiene prior to injection and subsequent re-use of the needle could lead to the contamination of the syringe with skin flora. Storage of cottons/filters and cookers already exposed to wet material could provide an environment for bacteria to remain viable and proliferate. The re-use of this drug injection equipment not only exposes the PWID to bacteria [45] but potentially a higher inoculum than other possible pathways for bacterial introduction. This study indicates the need for widespread provision of harm reduction supplies to PWID including clean injecting equipment and sterile water. The evolving opioid epidemic coupled with limited knowledge of potential risk factors and increasing incidence of SBI in PWID, provides a significant opportunity for intervention that may reduce morbidity and mortality in this vulnerable population.

What causes skin infections in people who inject drugs?