Intended for healthcare professionals

Practice Practice Pointer

Acute infections in people who inject drugs

BMJ 2022; 379 doi: (Published 07 October 2022) Cite this as: BMJ 2022;379:e072635
  1. Neil Stevenson, specialty registrar in infectious diseases1,
  2. Stuart Suttie, consultant vascular surgeon2,
  3. Eduardo Fernandes, assistant professor3,
  4. Nikolas Rae, consultant physician in infectious diseases and acute medicine1
  1. 1Infection Unit, Ninewells Hospital, Dundee DD1 9SY, UK
  2. 2Department of Vascular Surgery, Ninewells Hospital, Dundee
  3. 3Department of Surgery, University of Illinois Health Science System, Chicago, Illinois, USA
  1. Correspondence to: N Rae

What you need to know

  • Have a low threshold for imaging with computed tomography (CT) angiography, thoracic CT, and echocardiography in people who inject drugs presenting with acute infections

  • Arrange urgent surgical referral for patients with pseudoaneurysm, abscess, necrotising soft tissue infection, or septic arthritis

  • Early switch to oral antimicrobial therapy, once clinically stable, may improve compliance and can be as effective as intravenous therapy

A39 year old man presents to the emergency department with a seven day history of fever and rigors associated with pain and swelling in the right leg. He had recently injected heroin into the right groin before the onset of pain. On admission he was febrile, tachycardic, and tachypnoeic with audible crackles in both lung fields, and had cellulitis of the right leg.

About 275 million people inject drugs according to the UN 2021 World Drug Report, an increase of 22% from 2010.1 Acute bacterial infections are common in people who inject drugs. The diagnosis is often delayed as they may hesitate to seek prompt care due to stigma and fear. Mortality can be high due to complications and delayed treatment.

This article aims to highlight key points for the generalist in the initial assessment and management of common infections in people who inject drugs.

Why is it important?

People who inject drugs are less likely to receive primary care than the general population.2 This may worsen severity of disease. A Canadian retrospective study (663 patients) showed higher rates of emergency department attendance and hospital admission than in the general population.3

Estimates from the United States suggest 20 000 hospital admissions for infective endocarditis and 98000 hospitalizations and emergency department visits for skin and soft-tissue infections related to injecting drug use in 2017.4 A retrospective cohort study from a teaching hospital in London revealed infections contributed to at least 90% …

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