Stopka Thomas J, Nance Robin M, Mixson L Sarah, Spencer Hunter, Tsui Judith I, Leahy Judith M, Pho Mai T, DeJace Jean, Feinberg Judith, Young April M, Yang Wei-Teng, Baltes Amelia, Romo Eric, Brown Randall T, Nolte Kerry, Miller William C, Zule William A, Jenkins Wiley D, Delaney Joseph A, Friedmann Peter D
Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA 02111, USA.
Department of Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195, USA.
Trop Med Infect Dis. 2025 Jan 9;10(1):17. doi: 10.3390/tropicalmed10010017.
Limited research has examined the possible synergistic interrelationships between serious bacterial infections (SBIs) of the heart (i.e., endocarditis), bone, spine, brain, or joints (e.g., osteomylelitis) and hepatitis C virus (HCV) infections. We examined whether syndemic interactions existed between SBI, HCV, and substance-use-related factors in rural communities, hypothesizing that injection-mediated risks elevated the likelihood for both SBIs and HCV infections, which could be exacerbated by synergistic biological-biological or biological and social interactions. We calculated the prevalence ratios (PRs) of past-year SBI associated with each risk factor in separate models. Effect modification among significant risk factors was assessed using multiplicative interaction. Among 1936 participants, 57% were male and 85% White, with a mean age of 36 years. Eighty-nine participants (5%) reported hospitalization for an SBI in the year prior to the survey. More than half tested HCV-antibody-positive (58%); 62 (5.6%) of the participants with a positive HCV antibody result reported past-year hospitalization with an SBI. Injection behaviors were correlated with other SBI risk factors, including multiple injections in the same injection event (MIPIE), injection equipment sharing, and fentanyl use. In adjusted models, MIPIE (PR: 1.79; 95% confidence interval [CI]: 1.03, 3.11) and fentanyl use (PR: 1.68; 95% CI: 1.04, 2.73) were significantly associated with past-year SBI. Our analyses pointed to co-occurring epidemics of SBI and HCV, related to the cumulative health effects of fentanyl use contributing to frequent injections and MIPIE. Both the SBI and HCV epidemics present public health challenges and merit tailored interventions.
仅有有限的研究探讨了心脏（即心内膜炎）、骨骼、脊柱、大脑或关节的严重细菌感染（SBI，如骨髓炎）与丙型肝炎病毒（HCV）感染之间可能存在的协同相互关系。我们研究了农村社区SBI、HCV与物质使用相关因素之间是否存在共病相互作用，假设注射介导的风险增加了SBI和HCV感染的可能性，而生物-生物或生物与社会的协同相互作用可能会加剧这种情况。我们在单独的模型中计算了与每个风险因素相关的过去一年SBI的患病率比（PR）。使用乘法交互作用评估显著风险因素之间的效应修正。在1936名参与者中，57%为男性，85%为白人，平均年龄为36岁。89名参与者（5%）报告在调查前一年因SBI住院。超过一半的人HCV抗体检测呈阳性（58%）；62名（5.6%）HCV抗体检测结果呈阳性的参与者报告过去一年因SBI住院。注射行为与其他SBI风险因素相关，包括在同一注射事件中多次注射（MIPIE）、共用注射设备和使用芬太尼。在调整后的模型中，MIPIE（PR：1.79；95%置信区间[CI]：1.03，3.11）和使用芬太尼（PR：1.68；95%CI：1.04，2.73）与过去一年的SBI显著相关。我们的分析指出SBI和HCV同时流行，这与芬太尼使用导致频繁注射和MIPIE的累积健康影响有关。SBI和HCV流行都带来了公共卫生挑战，值得采取针对性的干预措施。
