Valencia Jorge, Troya Jesús, Lazarus Jeffrey V, Cuevas Guillermo, Alvaro-Meca Alejandro, Torres Juan, Gardeta Carlos, Lozano David, Moreno Santiago, Ryan Pablo
Harm Reduction Unit "SMASD," Addictions and Mental Health Department, Madrid, Spain.
Internal Medicine Service, University Hospital Infanta Leonor, Madrid, Spain.
Open Forum Infect Dis. 2021 May 25;8(7):ofab251. doi: 10.1093/ofid/ofab251. eCollection 2021 Jul.
An estimated 58 749 people with opioid use disorder engaged in opioid agonist therapy (OAT) in 1132 centers in Spain during 2017. We aimed to calculate the incidence of severe injection-related infections in people who inject drugs (PWID) engaged in OAT in harm reduction settings without a safe consumption space.
A retrospective cohort study was performed in PWID engaged in OAT and in a mobile harm reduction unit to quantify admissions to a referral hospital for any severe injection-related infections between 1 January 2016 and 31 December 2019. A Cox proportional hazard regression analysis was used to assess factors associated with any severe injection-related infection.
Two hundred thirty-seven PWID who engaged in OAT were included in the study. After a median follow-up of 5.5 months (interquartile range [IQR], 1.3-22.7 months), a total of 104 episodes of severe injection-related infections occurred among 56 individuals, and admission due to a second event occurred in 35.7% of this same group. The incidence density of any type of severe injection-related infection was 26.8 (95% confidence interval [CI], 20.2-34.8) episodes per 100 person-years, and the incidence density of complicated skin and soft tissue infections that required hospital admission was 20.4 (95% CI, 15.0-27.3) episodes per 100 person-years. Fifty-six (53.8%) of all the episodes were patient-directed discharge (PDD), and people who had 2 or more hospital admissions had a higher PDD frequency.
Severe injection-related infections remain highly prevalent among PWID cared for in a harm reduction setting without a safe consumption space. PDD was more frequent among higher-risk individuals who presented 2 or more hospital readmissions.
2017年，西班牙1132个中心估计有58749名患有阿片类药物使用障碍的人接受了阿片类激动剂治疗（OAT）。我们旨在计算在没有安全消费空间的减少伤害环境中接受OAT的注射吸毒者（PWID）中严重注射相关感染的发生率。
对接受OAT的PWID和一个流动减少伤害单位进行了一项回顾性队列研究，以量化2016年1月1日至2019年12月31日期间因任何严重注射相关感染而转诊至一家医院的入院人数。使用Cox比例风险回归分析来评估与任何严重注射相关感染相关的因素。
237名接受OAT的PWID被纳入研究。中位随访5.5个月（四分位间距[IQR]，1.3 - 22.7个月）后，56名个体共发生104次严重注射相关感染事件，其中35.7%的同一组个体因第二次事件入院。任何类型的严重注射相关感染的发病密度为每100人年26.8次（95%置信区间[CI]，20.2 - 34.8），需要住院治疗的复杂皮肤和软组织感染的发病密度为每100人年20.4次（95% CI，15.0 - 27.3）。所有事件中有56次（53.8%）是患者主导出院（PDD），有2次或更多次住院的人PDD频率更高。
在没有安全消费空间的减少伤害环境中接受护理的PWID中，严重注射相关感染仍然非常普遍。在有2次或更多次住院再入院的高风险个体中，PDD更为频繁。
