Clinical profile of injection drug users presenting to the ED

• Published in: The American journal of emergency medicine 2015-05, Vol.33 (5), p.674-676
• Main Authors: Kievlan, Daniel R., MD, Gukasyan, Meri, BS, Gesch, Julie, MD, Rodriguez, Robert M., MD
• Format: Article
• Language: English
• Subjects: Adult; Bacteremia - epidemiology; Bacteremia - microbiology; Bacterial infections; Blood; Confidence intervals; Drug Users; E coli; Emergency; Emergency medical care; Emergency medical services; Emergency Service, Hospital; Ethnicity; Family medical history; Female; Fever; Gram-positive bacteria; Health care access; HIV; Hospital Mortality; Hospitals; Human immunodeficiency virus; Humans; Hyponatremia - epidemiology; Illnesses; Infection - epidemiology; Infection - microbiology; Infectious diseases; Injection; Length of Stay - statistics & numerical data; Leukocytosis - epidemiology; Male; Microbiological culture; Middle Aged; Mortality; Prospective Studies; Risk assessment; Skin Diseases, Infectious - epidemiology; Skin Diseases, Infectious - microbiology; Soft Tissue Infections - epidemiology; Soft Tissue Infections - microbiology; Staphylococcus infections; Studies; Substance Abuse, Intravenous - epidemiology; Thrombocytopenia - epidemiology; Urine
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2015.02.020

Abstract Background Injection drug users (IDUs) commonly use the emergency department (ED) as their primary health care access point. Objective We sought to characterize infectious disease clinical presentations and laboratory results of IDUs admitted to the hospital from the ED and contrast them with those of non-IDUs. Methods We enrolled all admitted adult patients with infectious disease–related diagnoses at a county level 1 trauma center from June 2010 to January 2011 and used a structured chart abstraction tool to record patient characteristics and clinical outcomes. We compared clinical presenting features, laboratory data, and microbiological culture results of IDUs with concomitantly enrolled non-IDUs. Results Of 603 total participants, 189 were IDUs, and 414 were non-IDUs. Injection drug users had higher rates of skin and soft tissue infection admission but had similar hospital length of stay (7.5 vs 6.1 days) and mortality (2.1% vs 2.9%). Compared with non-IDUs, IDUs more commonly had hyponatremia, 38.1% vs 27.1% (mean difference, 11.4%; 95% confidence intervals [CIs], 3.4%-19.6%) and thrombocytopenia, 18.5% vs 11.0% (mean difference, 7.5%; 95% CI, 1.5%-14.2%) but less frequently had leukocytosis, 36.0% vs 52.7% (mean difference, 16.7%; 95% CI, 8.2%-24.8%). Injection drug users and non-IDUs had similar rates of positive ED-derived blood cultures, 16.5% vs 22.6% (mean difference, 6.1%; 95% CI, −13.3 to 1.7%). Conclusions When admitted from the ED for infectious disease–related diagnoses, IDUs had similar rates of fever, higher rates of hyponatremia and thrombocytopenia, and lower rates of leukocytosis than non-IDUs. Although they had similar rates of bacteremia, only IDUs were positive for methicillin-resistant Staphylococcus aureus.