Archives of Clinical Microbiology

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Extremity Infections in Intravenous Drug Abusers

Rahul Tyagi

Introduction: There has been a massive increase in intravenous drug users in the United Kingdom in last 40 years, estimated numbers in 2014 were 281,000 in England and more than 50,000 in Scotland accounting for the largest numbers in Europe. The use of intravenous drugs poses many potential health issues including soft tissue abscesses, osteomyelitis, and septic arthritis of joints, all of which may cause pain and disability.
Objective: To identify the current status of extremity infection involving soft tissues, bone and joints in intravenous drug users and review of the change in microbiology in last four decades.
Methods: A literature search was performed to identify English articles published in last 40 years and all available articles were reviewed to gather evidence on current understanding of change in microbiology and development of drug resistance.
Results: There has been a very steep increase in the incidence of soft tissue, bone and joint infections among intravenous drug abusers. Pseudomonas was the most commonly reported organism in 1960’s, and then Staphylococcus aureus became the organism responsible for 50% of the infections. However rapid emergence in oxacillin resistant staphylococcus aureus, community acquired methicillin resistant Staphylococcus aureus and outbreak of anthrax in the year 2009 has shown changing dynamics of microbiological pattern and difficulty in management of these cases.
Conclusion: Healthcare providers must address the challenges of complications associated with intravenous drug use to promote preventive strategies. To avoid development of antibiotic resistance, the administration of antibiotics must be supported by a framework that includes a comprehensive education and treatment strategy.