Abstract
Skin and soft tissue infections (SSTIs) are common complications of illicit drug use. Studies at single, urban hospitals demonstrate high rates of emergency department visits and hospitalizations for these infections. This study sought to estimate nationwide and regional incidence and costs of hospitalizations for illicit drug users with SSTIs in the US. AHRQ’s Nationwide Inpatient Sample was used to conduct a retrospective cross-sectional, time-series study. Hospitalizations of illicit drug users with SSTIs were identified using International Classification of Diseases, 9th Revision Clinical Modification codes. An estimated 106,126 hospitalizations for illicit drug users with SSTIs represented 0.07% of all US non-Federal hospitalizations from 1998 to 2001 and cost over 193 million dollars in 2001. Higher rates of hospitalization were found in the West, Northeast, and urban teaching hospitals. Hospitalization rates for illicit drug users with SSTIs vary significantly according to US region. Resources to reduce the incidence and severity of these infections should be targeted accordingly.
Similar content being viewed by others
References
Lloyd-Smith E, Kerr T, Hogg RS, et al. Prevalence and correlates of abscesses among a cohort of injection drug users. Harm Reduction Journal. 2005;2:24. doi:10.1186/1477-7517-2-24.
Stein MD, Sobota M. Injection drug users: hospital care and charges. Drug and Alcohol Dependence. 2001;64(1):117–120. doi:10.1016/S0376-8716(00)00235-0.
Makower RM, Pennycook AG, Moulton C. Intravenous drug abusers attending an inner city accident and emergency department. Archives of Emergency Medicine. 1992;9(1):32–39 (published erratum appears in Arch Emerg Med 1992 Sep;9(3):346).
Morrison A, Elliott L, Gruer L. Injecting-related harm and treatment-seeking behaviour among injecting drug users. Addiction. 1997;92(10):1349–1352. doi:10.1111/j.1360-0443.1997.tb02853.x.
Stone MH, Stone DH, MacGregor HA. Anatomical distribution of soft tissue sepsis sites in intravenous drug misusers attending an accident and emergency department. British Journal of Addiction. 1990;85(11):1495–1496. doi:10.1111/j.1360-0443.1990.tb01634.x.
Binswanger IA, Kral AH, Bluthenthal RN, et al. High prevalence of abscesses and cellulitis among community-recruited injection drug users in San Francisco. Clinical Infectious Diseases. 2000;30(3):579–581. doi:10.1086/313703.
Stein MD. Medical complications of intravenous drug use [see comments]. Journal of General Internal Medicine. 1990;5(3):249–257. doi:10.1007/BF02600544.
Haverkos HW, Lange WR. From the Alcohol, Drug Abuse, and Mental Health Administration. Serious infections other than human immunodeficiency virus among intravenous drug abusers. Journal of Infectious Diseases. 1990;161(5):894–902 (published erratum appears in J Infect Dis 1990 Dec;162(6):1421).
Horn EH, Henderson HR, Forrest JA. Admissions of drug addicts to a general hospital: a retrospective study in the northern district of Glasgow. Scottish Medical Journal. 1987;32(2):41–45.
Schnall SB, Holtom PD, Lilley JC. Abscesses secondary to parenteral abuse of drugs. A study of demographic and bacteriological characteristics. Journal of Bone & Joint Surgery – American Volume. 1994;76(10):1526–1530.
Wallace JR, Lucas CE, Ledgerwood AM. Social, economic, and surgical anatomy of a drug-related abscess. American Surgeon. 1986;52(7):398–401.
Palepu A, Tyndall MW, Leon H, et al. Hospital utilization and costs in a cohort of injection drug users. Canadian Medical Association Journal. 2001;165(4):415–420.
Ciccarone DJB, Kral AH, Edlin BR, et al. Soft tissue infections among injection drug users—San Francisco, California, 1996–2000. MMWR Weekly. 2001;50(19):381–384.
Kerr T, Wood E, Grafstein E, et al. High rates of primary care and emergency department use among injection drug users in Vancouver. Journal of Public Health. 2005;27(1):62–66. doi:10.1093/pubmed/fdh189.
Takahashi TA, Baernstein A, Binswanger I, et al. Predictors of hospitalization for injection drug users seeking care for soft tissue infections. Journal of General Internal Medicine. 2007;22(3):382–388. doi:10.1007/s11606-006-0079-y.
Office of National Drug Control Policy. The economic costs of drug abuse in the United States 1992–2002. Washington, D.C.: Executive Office of the President (Publication No. 207303); 2004.
U.S. Department of Health and Human Services. International classification of diseases, ninth revision, clinical modification. 5th edn. Washington: US Government Printing Office; 1999.
HCUP Nationwide Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP). 2000–2001. Agency for Healthcare Research and Quality R, MD. http://www.hcup-us.ahrq.gov/nisoverview.jsp.
Bradley CJ, Zarkin GA. An inpatient profile of patients with a substance abuse diagnosis in Maryland. Journal of Substance Abuse Treatment. 1997;14(2):155–162. doi:10.1016/S0740-5472(96)00124-9.
Anderson EJ, Hawkins C, Bolon MK, et al. A series of skin and soft tissue infections due to methicillin-resistant Staphylococcus aureus in HIV-infected patients. Journal of Acquired Immune Deficiency Syndromes: JAIDS. 2006;41(1):125–127. doi:10.1097/01.qai.0000192004.08153.ea.
Olsen RJ, Burns KM, Chen L, et al. Severe necrotizing fasciitis in a human immunodeficiency virus-positive patient caused by methicillin-resistant Staphylococcus aureus. Journal of Clinical Microbiology. 2008;46(3):1144–1147. doi:10.1128/JCM.02029-07.
Skiest D, Brown K, Hester J, et al. Community-onset methicillin-resistant Staphylococcus aureus in an urban HIV clinic. HIV Medicine. 2006;7(6):361–368. doi:10.1111/j.1468-1293.2006.00394.x.
Dans PE, Matricciani RM, Otter SE, et al. Intravenous drug abuse and one academic health center. Journal of the American Medical Association. 1990;263(23):3173–3176. doi:10.1001/jama.263.23.3173.
Centers for Disease Control and Prevention. HIV prevalence trends in selected populations in the United States: results from national serosurveillance, 1993–1997. Atlanta: Centers for Disease Control and Prevention; 2001:1–51.
Murphy EL, DeVita D, Liu H, et al. Risk factors for skin and soft-tissue abscesses among injection drug users: a case-control study. Clinical Infectious Diseases. 2001;33(1):35–40. doi:10.1086/320879.
Vlahov D, Sullivan M, Astemborski J, et al. Bacterial infections and skin cleaning prior to injection among intravenous drug users. Public Health Reports. 1992;107(5):595–598.
Harris HW, Young DM. Care of injection drug users with soft tissue infections in San Francisco, California. Archives of Surgery. 2002;137(11):1217–1222. doi:10.1001/archsurg.137.11.1217.
Author information
Authors and Affiliations
Corresponding author
Additional information
The research reported in this paper was supported by the National Institute on Drug Abuse (NIDA #RO3DA14518) and the Health Services Research and Development Service and the Seattle Epidemiologic Research and Information Center of the Department of Veterans Affairs Office of Research and Development, Seattle, WA. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs, the University of Washington, or Duke University. This study was presented as a poster at the Society of General Internal Medicine 28th Annual Meeting, New Orleans, Louisiana, May 11–14, 2005. Dr. Takahashi is a staff physician at the VA Puget Sound Health Care System. Dr. Maciejewski is an investigator at the Duke University Medical Center. Dr. Bradley is an investigator in Health Services Research and Development, Primary and Specialty Medical Care, and the VA Center for Substance Abuse Treatment and Education (CESATE) at the VA Puget Sound Health Care System.
Rights and permissions
About this article
Cite this article
Takahashi, T.A., Maciejewski, M.L. & Bradley, K. US Hospitalizations and Costs for Illicit Drug Users with Soft Tissue Infections. J Behav Health Serv Res 37, 508–518 (2010). https://doi.org/10.1007/s11414-009-9177-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11414-009-9177-z