注射吸毒者中与皮肤注射相关感染住院的决定因素：一项队列研究。
Determinants of hospitalization for a cutaneous injection-related infection among injection drug users: a cohort study.
机构信息
British Columbia Centre for Excellence in HIV/AIDS, Providence Health Care, 608-1081 Burrard Street, Vancouver, V6Z 1Y6, Canada.
出版信息
BMC Public Health. 2010 Jun 9;10:327. doi: 10.1186/1471-2458-10-327.
BACKGROUND
Cutaneous injection-related infections (CIRI) are a primary reason individuals who inject drugs (IDU) are hospitalized. The objective of this study was to investigate determinants of hospitalization for a CIRI or related infectious complication among a cohort of supervised injection facility (SIF) users.
METHODS
From 1 January 1 2004 until 31 January 2008, using Cox proportional hazard regression, we examined determinants of hospitalization for a CIRI or related infectious complication (based on ICD 10 codes) among 1083 IDU recruited from within the SIF. Length of stay in hospital and cost estimates, based on a fully-allocated costing model, was also evaluated.
RESULTS
Among hospital admissions, 49% were due to a CIRI or related infectious complication. The incidence density for hospitalization for a CIRI or related infectious complication was 6.07 per 100 person-years (95% confidence intervals [CI]: 4.96 - 7.36). In the adjusted Cox proportional hazard model, being HIV positive (adjusted hazard ratio [AHR] = 1.79 [95% CI: 1.17 - 2.76]) and being referred to the hospital by a nurse at the SIF (AHR = 5.49 [95% CI: 3.48 - 8.67]) were associated with increased hospitalization. Length of stay in hospital was significantly shorter among participants referred to the hospital by a nurse at the SIF when compared to those who were not referred (4 days [interquartile range {IQR}: 2-7] versus 12 days [IQR: 5-33]) even after adjustment for confounders (p = 0.001).
CONCLUSIONS
A strong predictor of hospitalization for a CIRI or related infectious complication was being referred to the hospital by a nurse from the SIF. This finding indicates that nurses not only facilitate hospital utilization but may provide early intervention that prevents lengthy and expensive hospital visits for a CIRI or related infectious complication.
背景
与皮肤注射相关的感染（CIRI）是导致吸毒者（IDU）住院的主要原因。本研究的目的是调查监管注射设施（SIF）使用者队列中因 CIRI 或相关感染性并发症住院的决定因素。
方法
从 2004 年 1 月 1 日至 2008 年 1 月 31 日，我们使用 Cox 比例风险回归，在 SIF 内招募的 1083 名 IDU 中，检查因 CIRI 或相关感染性并发症（基于 ICD-10 代码）住院的决定因素。还评估了基于全分配成本模型的住院时间和成本估算。
结果
在住院治疗中，49%是由于 CIRI 或相关感染性并发症。CIRI 或相关感染性并发症住院的发病率密度为每 100 人年 6.07 例（95%置信区间 [CI]：4.96-7.36）。在调整后的 Cox 比例风险模型中，HIV 阳性（调整后的危险比 [AHR] = 1.79 [95% CI：1.17-2.76]）和由 SIF 护士转介到医院（AHR = 5.49 [95% CI：3.48-8.67]）与住院增加相关。与未转介到医院的参与者相比，由 SIF 护士转介到医院的参与者的住院时间明显缩短（4 天 [四分位距 {IQR}：2-7] 与 12 天 [IQR：5-33]），即使在调整了混杂因素后（p = 0.001）。
结论
因 CIRI 或相关感染性并发症住院的一个强有力预测因素是由 SIF 的护士转介到医院。这一发现表明，护士不仅促进了医院的利用，而且可能提供早期干预，从而防止因 CIRI 或相关感染性并发症而进行漫长而昂贵的医院就诊。
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