RESEARCH ARTICLE
Determinants of Cutaneous Injection-Related Infections Among Injection Drug Users at an Emergency Department
Elisa Lloyd-Smith1, 2, Mark Tyndall1, 2, 3, Ruth Zhang1, Eric Grafstein4, Sam Sheps2, Evan Wood1, 2, 3, Julio Montaner1, 3, Thomas Kerr1, 3
Article Information
Identifiers and Pagination:
Year: 2012Volume: 6
First Page: 5
Last Page: 11
Publisher Id: TOIDJ-6-5
DOI: 10.2174/1874279301206010005
Article History:
Received Date: 30/6/2011Revision Received Date: 22/8/2011
Acceptance Date: 8/11/2011
Electronic publication date: 16/2/2012
Collection year: 2012
open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
Introduction:
Cutaneous injection-related infections (CIRI) are a primary reason injection drug users (IDU) access the emergency department (ED).
Methodology:
Using Cox proportional hazard regression, we examined predictors of ED use for CIRI, stratified by sex, among 1083 supervised injection facility (SIF) users.
Results:
Over a four-year period, 289 (27%) visited the ED for CIRI, yielding an incidence density for females of 23.8 (95% confidence interval (CI): 19.3 – 29.0) and males of 19.2 per 100 person-years (95% CI: 16.7 – 22.1). Factors associated with ED use for CIRI among females included residing in the Downtown Eastside (DTES) (adjusted hazard ratio [AHR] = 2.06 [1.13 – 3.78]) and being referred to hospital by SIF nurses (AHR = 4.48 [2.76 – 7.30]). Among males, requiring assistance with injection (AHR = 1.38 [1.01 – 1.90]), being HIV-positive (AHR = 1.85 [1.34 – 2.55]), and being referred to hospital by SIF nurses (AHR = 2.97 [1.93 – 4.57]) were associated with an increased likelihood of an ED visit for CIRI.
Conclusion:
These results suggest SIF nurses have facilitated referral of hospital treatment for CIRI, highlighting the need for continued development of efficient and collaborative efforts to reduce the burden of CIRI.