Infections and Drug Use-Related Morbidity and Mortality among People Who Use Drugs

项目摘要 在美国，与药物使用相关的细菌和真菌感染正在大幅增加。两 皮肤和软组织感染（SSTI）和感染性心内膜炎（IE）等感染可导致严重的 吸毒者的疾病或死亡（PWUD）。SSTI，如脓肿和蜂窝织炎， 高达65%的注射毒品者报告最近的SSTI。IE是一种心脏感染， 通常需要长期住院治疗。除了这些感染，一些PWUD还面临其他压力， 健康问题，特别是阿片类药物使用障碍和过量。预防相关的死亡率可能是一个 是导致PWUD全因死亡的主要因素。然而，从人口角度来看， 已知与药物过量相关的感染相关死亡率的决定因素和负担 在PWUD中。在一些PWUD中，阿片类药物使用障碍是一种潜在的严重但可治疗的疾病。FDA 已知批准的药物可以减少阿片类药物使用障碍症状并改变潜在行为 这可能会增加感染和过量的风险，例如注射毒品。种族、民族和性别 在获得和使用阿片类药物使用障碍（MOUD）药物方面存在不公平现象， 这些身份在MOUD访问或使用中的交叉性在那些接受护理的人中是未知的， 传染病这项建议的总体目标是扩大有关下列方面的知识基础： 感染相关死亡率、致死性和非致死性药物过量以及诊断为 SSTI和IE，特别关注阿片类药物使用障碍。首先，该项目将记录 以及PWUD中感染和药物过量死亡率的预测因素，特别关注那些面临 这些感染。此外，我们将量化MOUD对提高生存率和改善健康的影响 PWUD与SSTI和IE的结局。最后，该项目将按种族、族裔、 和性别。该项目将利用超过一半的北卡罗来纳州的医疗记录的广泛数据集 与死亡证明数据相关联。本研究的具体目的是（1）评估感染相关的预测因子 （2）估计MOUD对感染相关死亡率的影响， 诊断为SSTI或IE的PWUD中药物过量死亡率，以及（3）检查MOUD的接收情况， 按人种、种族和性别对诊断为SSTI或IE的PWUD的持续性进行评估。伴随 建议的研究，主要研究者的专门培训计划将提高她在以下方面的技能：（1） 药物使用相关健康结果的研究设计，（2）使用 翻译研究中的行政数据，以及（3）专业发展和研究传播， 科学和社区环境。通过多学科的拟议研究和指导， 团队，主要研究者将进行专门的培训计划，这将奠定基础， 职业生涯作为一个独立的研究人员在物质使用流行病学和转化研究领域。

PROJECT ABSTRACT Bacterial and fungal infections associated with drug use are increasing substantially in the United States. Two such infections, skin and soft tissue infections (SSTI) and infective endocarditis (IE), can lead to significant illness or death among people who use drugs (PWUD). SSTIs, such as abscesses and cellulitis, are highly prevalent with up to 65% of people who inject drugs reporting recent SSTIs. IE is an infection of the heart that typically requires long-term hospitalization. In addition to these infections, some PWUD face other pressing health concerns, most notably opioid use disorder and overdose. Infection-related mortality may be a substantial contributor to all-cause mortality among PWUD. However, from a population perspective, little is known about the determinants and burden of infection-related mortality relative to drug overdose among PWUD. Among some PWUD, opioid use disorder is a potentially serious yet treatable condition. FDA approved medications are known to reduce opioid use disorder symptoms and modify underlying behaviors that may increase risk of infections and overdose, such as injection drug use. Race, ethnicity, and gender inequities in access to and use of medication for opioid use disorder (MOUD) exist, and the role of intersectionality of these identities in MOUD access or use are not known among those receiving care for infectious diseases. The overall objective of this proposal is to expand the knowledge base concerning infection-related mortality, fatal and nonfatal drug overdose, and all-cause mortality in PWUD diagnosed with SSTIs and IE, with a particular focus on opioid use disorder. Primarily, the project will document the burden and predictors of infection and drug overdose mortality among PWUD with a particular focus on those facing these infections. Additionally, we will quantify the effect of MOUD on increasing survival and improving health outcomes in PWUD with SSTIs and IE. Finally, the project will examine disparities in MOUD by race, ethnicity, and gender. The project will utilize an extensive dataset of healthcare records for over half of North Carolinians linked with death certificate data. The specific aims of this study are to (1) assess predictors of infection-related mortality and drug overdose among PWUD, (2) estimate the effect of MOUD on infection-related mortality and drug overdose mortality among PWUD diagnosed with SSTIs or IE, and (3) examine receipt of MOUD and continuation among PWUD diagnosed with SSTIs or IE by race, ethnicity, and gender. Accompanying the proposed research, a specialized training plan for the principal investigator will enhance her skill set in: (1) study design of drug use-related health outcomes, (2) robust methodological approaches to the use of administrative data in translational research, and (3) professional development and research dissemination in scientific and community settings. Through the proposed research and mentorship from a multidisciplinary team, the principal investigator will undertake a specialized training program that will lay the foundation for a career as an independent researcher in the areas of substance use epidemiology and translational research.