Section of Infectious Diseases, Boston Medical Center, 801 Massachusetts Ave, 2nd floor, Boston 02118, MA, USA.
Boston University School of Public Health, Boston, MA, USA; Behavioral Medicine and Addictions Research, Butler Hospital, Providence, RI, USA.
Int J Drug Policy. 2021 Aug;94:103198. doi: 10.1016/j.drugpo.2021.103198. Epub 2021 Mar 18.
Sharing needles and injection drug preparation equipment (IDPE) among people who inject drugs (PWID) are well-established risk factors for viral transmission. Shared needles and IDPE may serve as bacterial niduses for skin and soft tissue infections (SSTI). Given the rising rates of SSTI in PWID, we investigated the association of needle and IDPE sharing on incidence of SSTI in a cohort of PWID.
Inpatient PWID (N = 252) were recruited to a randomized controlled trial of an intervention aimed at reducing infections. The primary outcome was self-reported incidence of SSTI one-year post-hospitalization. In this secondary analysis, we assessed two variables: 1) sharing of IDPE alone, 2) sharing needles with or without IDPE, and compared these groups separately to persons who reported no sharing of needles or IDPE via a mixed-effects negative binomial regression model to estimate the effect of baseline sharing behavior on SSTI during follow-up via incidence rate ratios (IRR).
Participant characteristics: 38 years [mean], 58% male, 60% White, 90% primarily injected opioids, 1.58 (± 2.35) mean SSTI in the year prior to baseline. In terms of sharing behavior, 29% didn't share needles or IDPE, 13% shared IDPE only, and 58% shared needles with or without IDPE three months prior to baseline. After adjusting for co-variables, PWID who shared IDPE alone had a 2.2 fold higher IRR of SSTI (95%CI 1.27; 3.85, p = 0.005) and PWID who shared needles with or without IDPE had a 3.31 fold higher IRR of SSTI (95%CI 2.04; 5.37, p < 0.001), compared to those who did not share any equipment. The number of SSTI at baseline was associated with an IRR of 1.20 of SSTI during follow-up (95%CI 1.09; 1.32, p < 0.001).
In this cohort of hospitalized PWID, we found a significant association between baseline sharing of IDPE alone and of sharing of needles with or without IDPE with one-year incidence of SSTI.
在注射毒品者（PWID）中，共用针具和注射药物准备设备（IDPE）是病毒传播的既定风险因素。共用的针具和 IDPE 可能成为皮肤和软组织感染（SSTI）的细菌巢穴。鉴于 PWID 中 SSTI 的发病率不断上升，我们研究了在一组 PWID 中，针具和 IDPE 共享与 SSTI 发生率之间的关联。
我们招募了 252 名住院 PWID 参加一项旨在减少感染的干预措施的随机对照试验。主要结局是住院一年后自我报告的 SSTI 发生率。在这项二次分析中，我们评估了两个变量：1）单独共享 IDPE，2）共用针具和/或 IDPE，通过混合效应负二项回归模型分别将这些组与报告未共享针具或 IDPE 的人进行比较，以估计基线共享行为对随访期间 SSTI 的影响，通过发病率比（IRR）进行估计。
参与者特征：38 岁[均值]，58%为男性，60%为白人，90%主要注射阿片类药物，基线前一年有 1.58（±2.35）次 SSTI。在共享行为方面，29%的人不共享针具或 IDPE，13%的人仅共享 IDPE，58%的人在基线前三个月共享针具和/或 IDPE。在调整协变量后，单独共享 IDPE 的 PWID 发生 SSTI 的 IRR 高 2.2 倍（95%CI 1.27；3.85，p=0.005），共用针具和/或 IDPE 的 PWID 发生 SSTI 的 IRR 高 3.31 倍（95%CI 2.04；5.37，p<0.001），与不共享任何设备的人相比。基线处的 SSTI 数量与随访期间 SSTI 的 IRR 为 1.20 相关（95%CI 1.09；1.32，p<0.001）。
在本队列住院的 PWID 中，我们发现单独共享 IDPE 和共用针具和/或 IDPE 与一年 SSTI 发生率之间存在显著关联。
