Abstract
BackgroundBacterial infection is a major cause of morbidity and mortality for persons who inject drugs (PWID). Injection cessation may help abrogate such infections, but maintaining complete cessation is challenging. Limited data exists on the role of reduced injection intensity on invasive bacterial infection risk. We sought to evaluate decreased risk for bacterial infections following cessation and substantive reduction in the injection intensity.MethodsParticipants were persons in the AIDS Linked to the Intravenous Experience (ALIVE) cohort with initial high-frequency injection drug use (> 1 daily). Pooled logistic regression with generalized estimating equations was used to estimate risk for invasive bacterial infection (pneumonia, endocarditis, or sepsis) among participants achieving complete injection cessation or reduced injection intensity relative to those with sustained high-frequency use.ResultsOf 2247 study participants with 12,469 paired study visits, complete injection cessation was achieved at 13.5% and reduced injection intensity at 25.5% of study visits. Adjusting for sociodemographics and HIV status, injection cessation was associated with a 54% reduction of bacterial infection at 3 months (odds ratio [OR] 0.46, 95% CI 0.25–0.84) and a 46% reduction at 6 months (OR 0.54, 95% CI 0.36–0.81). Reduced injection intensity was associated with a 36% reduction of infection at 3 months (OR 0.64, 95% CI 0.43–0.96) and a 26% reduction at 6 months (OR 0.74, 95% CI 0.56–0.98).ConclusionsBoth complete cessation and reduced injection frequency demonstrate substantial benefit in reducing invasive bacterial infection risk among PWID. With high rates of relapse into injection use, targeting sustained reductions in drug use intensity may be a key harm reduction modality for improving clinical outcomes in this population.
Highlights
People who inject drugs (PWID) are associated with increased risk of local soft tissue bacterial infection, with subsequent serious risk for invasive sepsis, pneumonia, and infective endocarditis (IE) [1,2,3]
Little data exists on whether complete cessation of injection is necessary for significant improvement in clinical outcomes, or whether clinical gains may be achieved through reductions in injection intensity
Recognizing complete cessation occurs infrequently, we evaluated the risk for invasive bacterial infections including bacterial pneumonia, sepsis, and endocarditis, among people who inject daily that transitioned to substantive reduction or to complete cessation in injection intensity during the subsequent 6 months
Summary
People who inject drugs (PWID) are associated with increased risk of local soft tissue bacterial infection, with subsequent serious risk for invasive sepsis, pneumonia, and infective endocarditis (IE) [1,2,3]. Multi-fold high risk of IE and community-acquired pneumonia were reported with the increased frequency of injection drug use [9, 10]. Recognizing complete cessation occurs infrequently, we evaluated the risk for invasive bacterial infections including bacterial pneumonia, sepsis, and endocarditis, among people who inject daily that transitioned to substantive reduction or to complete cessation in injection intensity during the subsequent 6 months. Limited data exists on the role of reduced injection intensity on invasive bacterial infection risk. We sought to evaluate decreased risk for bacterial infections following cessation and substantive reduction in the injection intensity
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
