Division of Infectious Diseases, Washington University in St. Louis School of Medicine, Campus Box 8051, 4523 Clayton Avenue, St. Louis, MO 63110-1093, USA.
Division of Infectious Diseases, Washington University in St. Louis School of Medicine, Campus Box 8051, 4523 Clayton Avenue, St. Louis, MO 63110-1093, USA.
Med Clin North Am. 2022 Jan;106(1):187-200. doi: 10.1016/j.mcna.2021.08.006.
The opioid overdose epidemic is one of the leading causes of death in adults. Its devastating effects have included not only a burgeoning overdose crisis but also multiple converging infectious diseases epidemics. The use of both opioids and other substances through intravenous (IV) administration places individuals at increased risks of infectious diseases ranging from invasive bacterial and fungal infections to human immunodeficiency virus (HIV) and viral hepatitis. In 2012, there were 530,000 opioid use disorder (OUD)-related hospitalizations in the United States (US), with $700 million in costs associated with OUD-related infections. The scale of the crisis has continued to increase since that time, with hospitalizations for injection drug use-related infective endocarditis (IDU-IE) increasing by as much as 12-fold from 2010 to 2015. Deaths from IDU-IE alone are estimated to result in over 7,260,000 years of potential life lost over the next 10 years. There have been high-profile injection-related HIV outbreaks, and injection drug use (IDU) is now the most common risk factor for hepatitis C virus (HCV). As this epidemic continues to grow, clinicians in all aspects of medical care are increasingly confronted with infectious complications of IDU. This review will describe the pathogenesis, clinical syndromes, epidemiology, and models of treatment for common infectious complications among persons who inject drugs (PWIDs).
阿片类药物过量流行是成年人死亡的主要原因之一。它的破坏性影响不仅包括日益严重的过量危机，还包括多种传染病的流行。静脉注射（IV）使用阿片类药物和其他物质会使个人面临从侵袭性细菌和真菌感染到人类免疫缺陷病毒（HIV）和病毒性肝炎等传染病的风险增加。2012 年，美国有 53 万例阿片类药物使用障碍（OUD）相关住院治疗，与 OUD 相关感染相关的费用为 7 亿美元。自那时以来，危机的规模继续扩大，2010 年至 2015 年，与注射药物使用相关的感染性心内膜炎（IDU-IE）相关的住院治疗增加了 12 倍。仅 IDU-IE 导致的死亡估计在未来 10 年内会导致超过 726 万的潜在生命损失。已经发生了备受瞩目的与注射有关的 HIV 爆发，而且注射药物使用（IDU）现在是丙型肝炎病毒（HCV）的最常见危险因素。随着这种流行病的持续增长，医疗保健各个方面的临床医生越来越多地面临与 IDU 相关的传染病并发症。这篇综述将描述注射吸毒者（PWIDs）中常见传染病并发症的发病机制、临床综合征、流行病学和治疗模式。
