Prevalence and severity of abscesses and cellulitis, and their associations with other health outcomes, in a community-based study of people who inject drugs in London, UK
Prevalence and severity of abscesses and cellulitis, and their associations with other health outcomes, in a community-based study of people who inject drugs in London, UK
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DOI：
10.1371/journal.pone.0235350
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发表时间：
2020-07-14
期刊：
影响因子：
3.7
通讯作者：
Harris, Magdalena
中科院分区：
文献类型：
--
作者：
Wright, Talen;Hope, Vivian;Harris, Magdalena
背景 皮肤和软组织感染 (SSTI) 是注射吸毒者 (PWID) 发病和死亡的常见但可预防的原因。这些症状可能很严重，并且患有 SSTI 的吸毒者住院人数正在上升。最常见的 SSTI 表现是脓肿和蜂窝织炎。方法 我们使用了伦敦吸毒者横断面社区调查“护理与预防”的数据。我们报告了 SSTI 的终生患病率、感染的严重程度、关键危险因素和相关后遗症。图画问题用于评估 SSTI 严重程度。结果 我们招募了 455 名吸毒者。 SSTI 终生患病率很高：64% 报告有脓肿和/或蜂窝织炎。超过三分之一 (37%) 的人报告严重感染，137 人 (47%) 报告住院治疗。 SSTI 危险因素为：年龄 35 岁以上、每天注射一次或多次、皮下或肌肉注射、尝试注射四次或以上。那些报告患有其他健康状况的人患脓肿或蜂窝织炎的可能性较高，而且风险往往随着报告的状况数量的增加而增加。一半 (46%) 的人在最严重的 SSTI 中采取自我护理，43% 的人等待十天或更长时间才寻求医疗护理或根本不寻求医疗护理。结论 伦敦吸毒者中脓肿和蜂窝织炎很常见。我们证实了表明 SSTI 与风险相关的研究结果，例如静脉通路问题，以及其他合并症：败血症、心内膜炎、DVT 和肾脏疾病。这些合并症可能会影响 SSTI 的严重程度和结果。延迟就医可能会加剧感染的严重程度，进而增加较差的健康结果和并发症。
Background Skin and soft tissue infections (SSTI) are a common but preventable cause of morbidity and mortality among people who inject drugs (PWID). They can be severe, and hospitalisations of PWID with SSTI are rising. The most common SSTI presentations are abscesses and cellulitis. Methods We used data from Care & Prevent, a cross-sectional community survey of PWID in London. We reported the lifetime prevalence of SSTI, severity of infections, key risk factors, and associated sequelae. Pictorial questions were used to assess SSTI severity. Results We recruited 455 PWID. SSTI lifetime prevalence was high: 64% reported an abscess and/or cellulitis. Over one-third (37%) reported a severe infection, 137 (47%) reported hospitalisation. SSTIrisk factors were: aged 35+ years, injecting once or more times a day, subcutaneous or intra-muscular injections, and making four or more attempts to achieve an injection. Those who reported having other health conditions were at higher odds of having an abscess or cellulitis, with risk tending to increase with number of reported conditions. Half (46%) employed self-care for their worst SSTI, and 43% waited for ten or more days before seeking medical care or not seeking medical care at all. Conclusions Abscess and cellulitis are very common among PWID in London. We corroborate findings indicating SSTIs are associated with risks, e.g. venous access problems, as well as other co-morbid conditions: septicaemia, endocarditis, DVT, and kidney disease. These co-morbidities may impact SSTIs severity and outcomes. Delayed healthcare seeking potentially exacerbates infection severity, which in turn increases poorer health outcomes and complications.