‘It’s not what you know but who you know’: Role of social capital in predicting risky injection drug use behavior in a sample of people who inject drugs in Baltimore City

Objective: Quantify incidence and determine predictors of Gram-negative bacilli (GNB) in people who inject drugs (PWID) with injection-drug use (IDU)-related infections. Design: Retrospective cohort of hospitalized PWID from 1/2017-12/2019. Methods: Inclusion criteria: age ≥18 years, active IDU, treated IDU-attributable infection, organism growth from microbiology cultures. Infection types: infective endocarditis (IE), acute bacterial skin/skin structure infection (ABSSSI), osteoarticular infection (OAI), other bloodstream infections (BSI). Primary outcome was GNB identification from microbiologic culture; descriptive statistics were used to describe the cohort. Multivariable regression was used to identify variables associated with GNB infection. Results: 230 PWID included; 65 (28%) GNB infections, 165 (72%) Gram-positive infections. The median (IQR) population age was 38 (31-45) years. Most patients were women (56%); 37% had no insurance. Infection types were: IE (41%), ABSSSI (37%), OAI (20%), other BSI (2%). 278 organisms were isolated from 230 patients; most common organisms were methicillin-resistant Staphylococcus aureus (43%), Streptococcus spp. (19%), methicillin-susceptible S. aureus (17%), Serratia marcescens (8%); 10% were mixed GNB and Gram-positive infections. 80% of patients received empiric Pseudomonas aeruginosa coverage; only 7% had P. aeruginosa infections. In multivariable regression, age >50 years (adjOR, 2.9; 95%CI; 1.2-7.2), prior hospitalization within 90-days (adjOR, 2.2; 95%CI; 1.2-4.3), and OAI (adjOR, 3.2; 95%CI; 1.5-6.6) were associated with GNB infection. Conclusions: GNB in PWID with IDU-attributed infections were more frequently observed in recently hospitalized, older patients with OAI. The majority of patients received empiric anti-pseudomonal antibiotic coverage, but P. aeruginosa was infrequent. PWID are a potential population to target improved empiric antibiotic use.

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Role of Social Network Dimensions in the Transition to Injection Drug Use: Actions Speak Louder than Words

AIDS and Behavior ◽

10.1007/s10461-011-9930-1 ◽

2011 ◽

Vol 15 (7) ◽

pp. 1579-1588 ◽

Cited By ~ 28

Author(s):

Nana Koram ◽

Hongjie Liu ◽

Jianhua Li ◽

Jian Li ◽

Jian Luo ◽

...

Keyword(s):

Social Network ◽

Drug Use ◽

Injection Drug Use ◽

Injection Drug

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Protective factors associated with short-term cessation of injection drug use among a Canadian cohort of people who inject drugs

Drug and Alcohol Review ◽

10.1111/dar.12364 ◽

2015 ◽

Vol 35 (5) ◽

pp. 620-627 ◽

Cited By ~ 5

Author(s):

Serena Luchenski ◽

Lianping Ti ◽

Kanna Hayashi ◽

Huiru Dong ◽

Evan Wood ◽

...

Keyword(s):

Drug Use ◽

Protective Factors ◽

Injection Drug Use ◽

People Who Inject Drugs ◽

Injection Drug ◽

Short Term ◽

Factors Associated

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Why the Treatment of Mental Disorders Is an Important Component of HIV Prevention among People Who Inject Drugs

Advances in Preventive Medicine ◽

10.1155/2013/690386 ◽

2013 ◽

Vol 2013 ◽

pp. 1-9 ◽

Cited By ~ 16

Author(s):

Elizabeth Buckingham ◽

Ezra Schrage ◽

Francine Cournos

Keyword(s):

Mental Health ◽

Mental Illness ◽

Drug Use ◽

Mental Disorders ◽

Hiv Infection ◽

Injection Drug Use ◽

People Who Inject Drugs ◽

Injection Drug ◽

Hiv Care ◽

Hiv Positive

People who inject drugs are more likely to be HIV positive and to have a mental disorder than the general population. We explore how the detection and treatment of mental illness among people who are injecting drugs are essential to primary and secondary prevention of HIV infection in this population. Aside from opioid addiction, few studies have been conducted on the links between mental disorders and injection-drug use. However, independent of the injection-drug use literature, a growing number of studies demonstrate that untreated mental illness, especially depression and alcohol/substance use disorders, is associated with HIV-related risk behaviors, acquiring HIV infection, failure to access HIV care and treatment, failure to adhere to HIV care and treatment, and increased morbidity and mortality from HIV-related diseases and comorbidities. In our review of both the published literature and gray literature we found a dearth of information on models for providing care for both opioid addiction and other mental illnesses regardless of HIV status, particularly in low- and middle-income countries. We therefore make recommendations on how to address the mental health needs of HIV-positive people who inject drugs, which include the provision of opioid substitution therapy and integrated mental health, substance abuse, and HIV services.

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