Abstract
During 2014-2017, CDC Emerging Infections Program surveillance data reported that the occurrence of invasive methicillin-resistant Staphylococcus aureus (MRSA) infections associated with injection drug use doubled among persons aged 18-49 years residing in Monroe County in western New York.* Unpublished surveillance data also indicate that an increasing proportion of all Candida spp. bloodstream infections in Monroe County and invasive group A Streptococcus (GAS) infections in 15 New York counties are also occurring among persons who inject drugs. In addition, across six surveillance sites nationwide, the proportion of invasive MRSA infections that occurred in persons who inject drugs increased from 4.1% of invasive MRSA cases in 2011 to 9.2% in 2016 (1). To better understand the types and frequency of these infections and identify prevention opportunities, CDC and public health partners conducted a rapid assessment of bacterial and fungal infections among persons who inject drugs in western New York. The goals were to assess which bacterial and fungal pathogens most often cause infections in persons who inject drugs, what proportion of persons who inject use opioids, and of these, how many were offered medication-assisted treatment for opioid use disorder. Medication-assisted treatment, which includes use of medications such as buprenorphine, methadone, and naltrexone, reduces cravings and has been reported to lower the risk for overdose death and all-cause mortality in persons who use opioids (2,3). In this assessment, nearly all persons with infections who injected drugs used opioids (97%), but half of inpatients (22 of 44) and 12 of 13 patients seen only in the emergency department (ED) were not offered medication-assisted treatment. The most commonly identified pathogen was S. aureus (80%), which is frequently found on skin. Health care visits for bacterial and fungal infections associated with injection opioid use are an opportunity to treat the underlying opioid use disorder with medication-assisted treatment. Routine care for patients who continue to inject should include advice on hand hygiene and not injecting into skin that has not been cleaned or to use any equipment contaminated by reuse, saliva, soil, or water (4,5).
Highlights
Because many infections are caused by skin flora such as S. aureus, injecting without first cleaning the injection site and washing hands increases the risk for bacterial and fungal infections
S. aureus, Candida spp. and GAS infections were identified by both culture and diagnostic codes
Infections with other pathogens or without a pathogen identified were identified by diagnostic codes only, and were more likely to be missed
Summary
Bacterial and Fungal Infections in Persons Who Inject Drugs — Western New York, 2017. The goals were to assess which bacterial and fungal pathogens most often cause infections in persons who inject drugs, what proportion of persons who inject use opioids, and of these, how many were offered medication-assisted treatment for opioid use disorder. Demographic information, infection sites, bacterial and fungal pathogens, history of human immunodeficiency virus (HIV), hepatitis B and C, and clinical outcomes were abstracted from medical records for all patients with injection drug use. Characteristics of persons who inject drugs and were evaluated in emergency departments or admitted to the hospital for bacterial or fungal infections (N = 111) — western New York, 2017*. (Continued) Characteristics of persons who inject drugs and were evaluated in emergency departments or admitted to the hospital for bacterial or fungal infections (N = 111) — western New York, 2017*. Most patients with an infection identified by culture (74%) had diagnostic codes for both substance use and an infection or pathogen
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