Intravenous Drug Use Related Upper Extremity Infections - Demographics and Clinical Impact
Taylor Pong, BS, MS1; Kamilcan Oflazoglu, MD; Lydia Helliwell, MD; Neal C. Chen, MD; Kyle R. Eberlin, MD
Massachusetts General Hospital, Boston, MA
Introduction: The increase in intravenous drug use (IVDU) is a growing public health concern. There are numerous healthcare-related consequences of the IVDU epidemic in the US and the incidence of IVDU-associated complications, including infections, has risen over the past 10 years. The purpose of this study was to estimate the differences in demographics, treatment course, and outcomes associated with upper extremity infections in patients with IVDU compared to non-IVDU.
Materials & Methods: This retrospective case-control study investigated 1,304 patients who presented with an upper extremity infection at our level 1 emergency department in 2015. After manually reviewing the records of patients with possible IVDU, 147 patients were found to have an IVDU-related infection and were randomly matched with 147 controls (upper extremity infection without history of IVDU) based upon age, sex, and race. We compared demographics, patient factors (tobacco use, employment status), infection specifics (location, type), and treatment parameters (type of intervention, length of stay, use and extent of imaging) between the two groups. We used McNemar's test for paired dichotomous variables, McNemar-Bowker's test for symmetry for paired nominal variables, and paired t-test for paired continuous variables.
Results: The rate of IVDU in all upper extremity infections was 11%. IVDU patients were significantly younger on average (36 vs. 50 years; p<0.001). Infection location in the IVDU group was more likely to be in a typical injection site (forearm; p<0.001; wrist; p=0.002), whereas the infection location in the non-IVDU group was more often at other sites (finger; p<0.001). Compared to the non-IVDU group, the IVDU group had 33% more hospital admissions and stayed in the hospital longer. The IVDU group received a CT scan more frequently (12% vs. 1.4%) and the mean number of upper extremity radiographs was higher in the IVDU group. Patients with IVDU related infections were more likely to undergo surgical I&D and more often received intravenous antibiotics (Table 1).
Conclusion: The treatment of upper extremity IVDU related infections results in greater utilization of healthcare resources compared with non-IVDU patients. This results in an increased burden for physicians and for our healthcare system, particularly in the setting of the current opioid crisis. The hand and upper extremity are highly susceptible to IVDU infections given the common sites of injection.
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