注射吸毒人群感染性心内膜炎的危险因素。
Risk factors of infective endocarditis in persons who inject drugs.
机构信息
Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.
Western University, London, ON, Canada.
出版信息
Harm Reduct J. 2020 Jun 5;17(1):35. doi: 10.1186/s12954-020-00378-z.
BACKGROUND
The rising incidence of infective endocarditis (IE) among people who inject drugs (PWID) has been a major concern across North America. The coincident rise in IE and change of drug preference to hydromorphone controlled-release (CR) among our PWID population in London, Ontario intrigued us to study the details of injection practices leading to IE, which have not been well characterized in literature.
METHODS
A case-control study, using one-on-one interviews to understand risk factors and injection practices associated with IE among PWID was conducted. Eligible participants included those who had injected drugs within the last 3 months, were > 18 years old and either never had or were currently admitted for an IE episode. Cases were recruited from the tertiary care centers and controls without IE were recruited from outpatient clinics and addiction clinics in London, Ontario.
RESULTS
Thirty three cases (PWID IE+) and 102 controls (PWID but IE-) were interviewed. Multivariable logistic regressions showed that the odds of having IE were 4.65 times higher among females (95% CI 1.85, 12.28; p = 0.001) and 5.76 times higher among PWID who did not use clean injection equipment from the provincial distribution networks (95% CI 2.37, 14.91; p < 0.001). Injecting into multiple sites and heating hydromorphone-CR prior to injection were not found to be significantly associated with IE. Hydromorphone-CR was the most commonly injected drug in both groups (90.9% cases; 81.4% controls; p = 0.197).
DISCUSSION
Our study highlights the importance of distributing clean injection materials for IE prevention. Furthermore, our study showcases that females are at higher risk of IE, which is contrary to the reported literature. Gender differences in injection techniques, which may place women at higher risk of IE, require further study. We suspect that the very high prevalence of hydromorphone-CR use made our sample size too small to identify a significant association between its use and IE, which has been established in the literature.
背景
在北美，因注射吸毒者（PWID）而导致的感染性心内膜炎（IE）发病率不断上升，这引起了人们的极大关注。在安大略省伦敦，PWID 人群中 IE 的发病率同时上升，且药物偏好也发生了变化，转为使用氢吗啡酮控释剂（CR），这促使我们研究导致 IE 的注射习惯细节，而这方面的内容在文献中尚未得到很好的描述。
方法
我们进行了一项病例对照研究，通过一对一访谈来了解 PWID 中与 IE 相关的危险因素和注射习惯。合格的参与者包括在过去 3 个月内有过注射毒品行为、年龄大于 18 岁且从未患有或目前正在因 IE 住院的人群。病例是从三级护理中心招募的，对照组则是从安大略省伦敦的门诊诊所和成瘾诊所招募的没有 IE 的 PWID。
结果
共采访了 33 例病例（PWIDIE+）和 102 例对照（PWID 但无 IE）。多变量逻辑回归显示，女性 IE 的可能性是男性的 4.65 倍（95%CI1.85，12.28；p=0.001），未使用省级分发网络提供的清洁注射设备的 PWID IE 的可能性是男性的 5.76 倍（95%CI2.37，14.91；p<0.001）。注射到多个部位和在注射前加热氢吗啡酮-CR 与 IE 无显著相关性。氢吗啡酮-CR 是两组中最常注射的药物（90.9%病例；81.4%对照；p=0.197）。
讨论
我们的研究强调了分发清洁注射材料以预防 IE 的重要性。此外，我们的研究表明，女性 IE 的风险更高，这与报告的文献相反。需要进一步研究女性在注射技术方面的性别差异，这可能会使女性面临更高的 IE 风险。我们怀疑，氢吗啡酮-CR 的高使用率使得我们的样本量太小，无法确定其使用与 IE 之间的显著关联，而这在文献中已经得到了证实。
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