农村吸毒人群中皮肤和软组织感染的预测因素。
Predictors of skin and soft tissue infections among sample of rural residents who inject drugs.
机构信息
Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
出版信息
Harm Reduct J. 2020 Dec 2;17(1):96. doi: 10.1186/s12954-020-00447-3.
INTRODUCTION
Skin and soft tissue infections (SSTIs) are among the leading causes of morbidity and mortality for people who inject drugs (PWID). Studies demonstrate that certain injection practices correlate with SSTI incidence among PWID. The opioid epidemic in the USA has particularly affected rural communities, where access to prevention and treatment presents unique challenges. This study aims to estimate unsafe injection practices among rural-dwelling PWID; assess treatments utilized for injection related SSTIs; and gather data to help reduce the overall risk of injection-related SSTIs.
METHODS
Thirteen questions specific to SSTIs and injection practices were added to a larger study assessing unmet health care needs among PWID and were administered at six syringe exchange programs in rural Wisconsin between May and July 2019. SSTI history prevalence was estimated based on infections reported within one-year prior of response and was compared to self-reported demographics and injection practices.
RESULTS
Eighty responses were collected and analyzed. Respondents were white (77.5%), males (60%), between the ages 30 and 39 (42.5%), and have a high school diploma or GED (38.75%). The majority of respondents (77.5%) reported no history of SSTI within the year prior to survey response. Females were over three times more likely to report SSTI history (OR = 3.07, p = 0.038) compared to males. Water sources for drug dilution (p = 0.093) and frequency of injecting on first attempt (p = 0.037), but not proper skin cleaning method (p = 0.378), were significantly associated with a history of SSTI. Injecting into skin (p = 0.038) or muscle (p = 0.001) was significantly associated with a history of SSTI. Injection into veins was not significantly associated with SSTI (p = 0.333).
CONCLUSION
Higher-risk injection practices were common among participants reporting a history of SSTIs in this rural sample. Studies exploring socio-demographic factors influencing risky injection practices and general barriers to safer injection practices to prevent SSTIs are warranted. Dissemination of education materials targeting SSTI prevention and intervention among PWID not in treatment is warranted.
简介
皮肤和软组织感染（SSTI）是导致注射吸毒者（PWID）发病率和死亡率的主要原因之一。研究表明，某些注射行为与 PWID 中 SSTI 的发生有关。美国的阿片类药物流行对农村社区的影响尤其严重，这些社区在预防和治疗方面面临着独特的挑战。本研究旨在估计农村地区 PWID 中的不安全注射行为；评估用于治疗与注射相关的 SSTI 的治疗方法；并收集数据以帮助降低与注射相关的 SSTI 的总体风险。
方法
在一项评估农村地区 PWID 未满足的医疗需求的更大研究中，专门针对 SSTI 和注射行为添加了 13 个问题，并于 2019 年 5 月至 7 月在威斯康星州的六个注射器交换计划中进行了管理。根据报告的感染情况，基于一年内的报告，对 SSTI 病史的患病率进行了估计。SSTI 病史与自我报告的人口统计学和注射行为进行了比较。
结果
共收集并分析了 80 份回复。受访者为白人（77.5%）、男性（60%）、年龄在 30 至 39 岁之间（42.5%）、并拥有高中文凭或同等学历（38.75%）。在调查回应前的一年内，大多数受访者（77.5%）没有 SSTI 病史。与男性相比，女性报告 SSTI 病史的可能性高出三倍以上（OR=3.07，p=0.038）。用水稀释药物的来源（p=0.093）和首次注射的频率（p=0.037），但不是正确的皮肤清洁方法（p=0.378），与 SSTI 病史显著相关。将药物注入皮肤（p=0.038）或肌肉（p=0.001）与 SSTI 病史显著相关。将药物注入静脉与 SSTI 无显著相关性（p=0.333）。
结论
在这个农村样本中，报告有 SSTI 病史的参与者中，风险更高的注射行为很常见。有必要研究影响风险注射行为的社会人口因素以及预防 SSTI 的更安全注射行为的一般障碍。需要向未接受治疗的 PWID 传播针对 SSTI 预防和干预的教育材料。
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