buprenorphine and Skin-Diseases--Bacterial

Injection drug users (IDUs) are at increased risk of various medical conditions, including bacterial skin and soft tissue infections (SSTIs). SSTIs, which are painful and can lead to life-threatening complications, are common but scarcely studied.. To investigate life time, past 12 month and past 30-day prevalence for SSTI related to injection drug use, in IDUs at Malmö syringe exchange program (Malmö SEP). To investigate factors associated with having ever had an SSTI.. IDUs were recruited from Malmö SEP (N = 80). They participated in a survey with questions about demographics, drug use, and experience of SSTIs. Factors independently associated with self-reported SSTI ever were assessed using logistic regression analysis.. The lifetime reported prevalence of SSTI was 58%, past 12 months 30%, and past 30 days 14%. Factors independently associated with SSTI ever were age (adjusted odds ratio [AOR] = 1.09; 95% confidence interval [CI] = 1.01-1.18), female sex (AOR = 6.75; 95% CI = 1.40-32.47), having ever injected prescribed drugs (AOR = 52.15; 95% CI = 5.17-525.67), and having ever injected in the neck (AOR = 8.08; 95% CI = 1.16-56.08).. SSTI is common among IDUs in Malmö. Women and those injecting in the neck or injecting prescribed drugs (crushed tablets/liquids), are more likely to have had an SSTI.

Topics: Adult; Amphetamine-Related Disorders; Buprenorphine; Buprenorphine, Naloxone Drug Combination; Drug Users; Female; Heroin Dependence; Housing; Humans; Ill-Housed Persons; Logistic Models; Male; Methadone; Methylphenidate; Middle Aged; Neck; Needle-Exchange Programs; Odds Ratio; Opioid-Related Disorders; Prescription Drugs; Prevalence; Sex Factors; Skin Diseases, Bacterial; Soft Tissue Infections; Substance Abuse, Intravenous; Surveys and Questionnaires; Sweden; Young Adult

Topics: Adult; Analgesics, Opioid; Buprenorphine; Humans; Injections, Subcutaneous; Male; Necrosis; Opioid-Related Disorders; Penis; Scrotum; Skin Diseases, Bacterial; Skin Ulcer; Streptococcal Infections; Streptococcus

i.v. buprenorphine hydrochloride (Subutex) misuse has been creating a number of medical complications, and cutaneous manifestations such as soft tissue infection are one of the commonest consequences. Between January 2004 and December 2006, amongst 130 i.v. buprenorphine abusers who presented to the National University Hospital, Singapore, cutaneous complications were identified in 45 patients (prevalence, 31%) with cellulitis and skin abscess being the commonest complications. Tissue and blood culture were positive in 19 (42%) patients and Methicillin-sensitive Staphylococcus aureus was the commonest microbiological isolate (20%). Univariate linear regression revealed significant relationships between body temperature (P = 0.03), heart rate (P = 0.02), respiratory rate (P < 0.001), total peripheral white cell count (P = 0.011), absolute neutrophil count (P < 0.001) and serum C-reactive protein (CRP) level (P < 0.001) on admission and through the duration of hospitalization. In multivariate analysis, respiratory rate on admission remained significantly associated with longer duration of hospitalization (P = 0.01). i.v. cloxacillin, i.v. crystallized penicillin and oral cloxacillin were the most commonly prescribed antibiotics while 11 (24%) patients required surgical treatment. The mean duration of hospitalization was 8 +/- 11 days and repeated cutaneous complications occurred in eight (18%) patients. In conclusion, cutaneous complications are common among i.v. buprenorphine users. Respiratory rates on admission predict duration of hospital stay. A high index of suspicion coupled with a correct choice of antibiotics based on local bacteriological surveillance is necessary in an attempt to reduce cutaneous complications and length of hospitalization.

Topics: Abscess; Adult; Buprenorphine; Cellulitis; Female; Humans; Injections, Intravenous; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Narcotic Antagonists; Opioid-Related Disorders; Singapore; Skin Diseases; Skin Diseases, Bacterial; Staphylococcal Infections