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
1 British Columbia Centre for Excellence in HIV/AIDS, Providence Health Care, 608-1081 Burrard Street, Vancouver, V6Z 1Y6, Canada
2 School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, V6T 1Z3, Canada
3 Department of Medicine, University of British Columbia, 10203-2275 Laurel Street, Vancouver, V5Z 1M9, Canada
4 Department of Emergency Medicine, University of British Columbia, 855 West 12th Ave, Vancouver, V5Z 1M9, Canada

© 2012 Lloyd-Smith et al.

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: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Correspondence: * Address correspondence to this author at the Urban Health Research Initiative, BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, B.C. V6Z 1Y6, Canada.Tel: (604) 806-9116; Fax: (604) 806- 9044; E-mail:



Cutaneous injection-related infections (CIRI) are a primary reason injection drug users (IDU) access the emergency department (ED).


Using Cox proportional hazard regression, we examined predictors of ED use for CIRI, stratified by sex, among 1083 supervised injection facility (SIF) users.


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.


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.

Keywords: Abscesses, cellulitis, emergency department, epidemiology, , gender, health services, injection drug use..