Reducing injection intensity is associated with decreased risk for invasive bacterial infection among high-frequency injection drug users

Salequl Islam, Damani Arnold Piggott, Alberto Moriggia, Jacquie Astemborski, Shruti Hemendra Mehta, David L Thomas, Gregory D Kirk

Research output: Contribution to journalArticle

Abstract

Background: Bacterial infection is a major cause of morbidity and mortality for persons who inject drugs (PWID). Injection cessation may help abrogate such infections, but maintaining complete cessation is challenging. Limited data exists on the role of reduced injection intensity on invasive bacterial infection risk. We sought to evaluate decreased risk for bacterial infections following cessation and substantive reduction in the injection intensity. Methods: Participants were persons in the AIDS Linked to the Intravenous Experience (ALIVE) cohort with initial high-frequency injection drug use (> 1 daily). Pooled logistic regression with generalized estimating equations was used to estimate risk for invasive bacterial infection (pneumonia, endocarditis, or sepsis) among participants achieving complete injection cessation or reduced injection intensity relative to those with sustained high-frequency use. Results: Of 2247 study participants with 12,469 paired study visits, complete injection cessation was achieved at 13.5% and reduced injection intensity at 25.5% of study visits. Adjusting for sociodemographics and HIV status, injection cessation was associated with a 54% reduction of bacterial infection at 3 months (odds ratio [OR] 0.46, 95% CI 0.25-0.84) and a 46% reduction at 6 months (OR 0.54, 95% CI 0.36-0.81). Reduced injection intensity was associated with a 36% reduction of infection at 3 months (OR 0.64, 95% CI 0.43-0.96) and a 26% reduction at 6 months (OR 0.74, 95% CI 0.56-0.98). Conclusions: Both complete cessation and reduced injection frequency demonstrate substantial benefit in reducing invasive bacterial infection risk among PWID. With high rates of relapse into injection use, targeting sustained reductions in drug use intensity may be a key harm reduction modality for improving clinical outcomes in this population.

Original languageEnglish (US)
Article number38
JournalHarm reduction journal
Volume16
Issue number1
DOIs
StatePublished - Jun 17 2019

Fingerprint

Drug Users
Bacterial Infections
Injections
Odds Ratio
Pharmaceutical Preparations
Harm Reduction
Bacterial Pneumonia
Endocarditis
Infection
Sepsis
Acquired Immunodeficiency Syndrome
Logistic Models
HIV
Morbidity
Recurrence

Keywords

  • Bacterial infection
  • Injection drug use
  • PWID with high frequency
  • PWID with reduced frequency

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Public Health, Environmental and Occupational Health
  • Psychiatry and Mental health

Cite this

@article{96ecf345b1d4425a808b4dd44bd4f6d5,
title = "Reducing injection intensity is associated with decreased risk for invasive bacterial infection among high-frequency injection drug users",
abstract = "Background: Bacterial infection is a major cause of morbidity and mortality for persons who inject drugs (PWID). Injection cessation may help abrogate such infections, but maintaining complete cessation is challenging. Limited data exists on the role of reduced injection intensity on invasive bacterial infection risk. We sought to evaluate decreased risk for bacterial infections following cessation and substantive reduction in the injection intensity. Methods: Participants were persons in the AIDS Linked to the Intravenous Experience (ALIVE) cohort with initial high-frequency injection drug use (> 1 daily). Pooled logistic regression with generalized estimating equations was used to estimate risk for invasive bacterial infection (pneumonia, endocarditis, or sepsis) among participants achieving complete injection cessation or reduced injection intensity relative to those with sustained high-frequency use. Results: Of 2247 study participants with 12,469 paired study visits, complete injection cessation was achieved at 13.5{\%} and reduced injection intensity at 25.5{\%} of study visits. Adjusting for sociodemographics and HIV status, injection cessation was associated with a 54{\%} reduction of bacterial infection at 3 months (odds ratio [OR] 0.46, 95{\%} CI 0.25-0.84) and a 46{\%} reduction at 6 months (OR 0.54, 95{\%} CI 0.36-0.81). Reduced injection intensity was associated with a 36{\%} reduction of infection at 3 months (OR 0.64, 95{\%} CI 0.43-0.96) and a 26{\%} reduction at 6 months (OR 0.74, 95{\%} CI 0.56-0.98). Conclusions: Both complete cessation and reduced injection frequency demonstrate substantial benefit in reducing invasive bacterial infection risk among PWID. With high rates of relapse into injection use, targeting sustained reductions in drug use intensity may be a key harm reduction modality for improving clinical outcomes in this population.",
keywords = "Bacterial infection, Injection drug use, PWID with high frequency, PWID with reduced frequency",
author = "Salequl Islam and Piggott, {Damani Arnold} and Alberto Moriggia and Jacquie Astemborski and Mehta, {Shruti Hemendra} and Thomas, {David L} and Kirk, {Gregory D}",
year = "2019",
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doi = "10.1186/s12954-019-0312-8",
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T1 - Reducing injection intensity is associated with decreased risk for invasive bacterial infection among high-frequency injection drug users

AU - Islam, Salequl

AU - Piggott, Damani Arnold

AU - Moriggia, Alberto

AU - Astemborski, Jacquie

AU - Mehta, Shruti Hemendra

AU - Thomas, David L

AU - Kirk, Gregory D

PY - 2019/6/17

Y1 - 2019/6/17

N2 - Background: Bacterial infection is a major cause of morbidity and mortality for persons who inject drugs (PWID). Injection cessation may help abrogate such infections, but maintaining complete cessation is challenging. Limited data exists on the role of reduced injection intensity on invasive bacterial infection risk. We sought to evaluate decreased risk for bacterial infections following cessation and substantive reduction in the injection intensity. Methods: Participants were persons in the AIDS Linked to the Intravenous Experience (ALIVE) cohort with initial high-frequency injection drug use (> 1 daily). Pooled logistic regression with generalized estimating equations was used to estimate risk for invasive bacterial infection (pneumonia, endocarditis, or sepsis) among participants achieving complete injection cessation or reduced injection intensity relative to those with sustained high-frequency use. Results: Of 2247 study participants with 12,469 paired study visits, complete injection cessation was achieved at 13.5% and reduced injection intensity at 25.5% of study visits. Adjusting for sociodemographics and HIV status, injection cessation was associated with a 54% reduction of bacterial infection at 3 months (odds ratio [OR] 0.46, 95% CI 0.25-0.84) and a 46% reduction at 6 months (OR 0.54, 95% CI 0.36-0.81). Reduced injection intensity was associated with a 36% reduction of infection at 3 months (OR 0.64, 95% CI 0.43-0.96) and a 26% reduction at 6 months (OR 0.74, 95% CI 0.56-0.98). Conclusions: Both complete cessation and reduced injection frequency demonstrate substantial benefit in reducing invasive bacterial infection risk among PWID. With high rates of relapse into injection use, targeting sustained reductions in drug use intensity may be a key harm reduction modality for improving clinical outcomes in this population.

AB - Background: Bacterial infection is a major cause of morbidity and mortality for persons who inject drugs (PWID). Injection cessation may help abrogate such infections, but maintaining complete cessation is challenging. Limited data exists on the role of reduced injection intensity on invasive bacterial infection risk. We sought to evaluate decreased risk for bacterial infections following cessation and substantive reduction in the injection intensity. Methods: Participants were persons in the AIDS Linked to the Intravenous Experience (ALIVE) cohort with initial high-frequency injection drug use (> 1 daily). Pooled logistic regression with generalized estimating equations was used to estimate risk for invasive bacterial infection (pneumonia, endocarditis, or sepsis) among participants achieving complete injection cessation or reduced injection intensity relative to those with sustained high-frequency use. Results: Of 2247 study participants with 12,469 paired study visits, complete injection cessation was achieved at 13.5% and reduced injection intensity at 25.5% of study visits. Adjusting for sociodemographics and HIV status, injection cessation was associated with a 54% reduction of bacterial infection at 3 months (odds ratio [OR] 0.46, 95% CI 0.25-0.84) and a 46% reduction at 6 months (OR 0.54, 95% CI 0.36-0.81). Reduced injection intensity was associated with a 36% reduction of infection at 3 months (OR 0.64, 95% CI 0.43-0.96) and a 26% reduction at 6 months (OR 0.74, 95% CI 0.56-0.98). Conclusions: Both complete cessation and reduced injection frequency demonstrate substantial benefit in reducing invasive bacterial infection risk among PWID. With high rates of relapse into injection use, targeting sustained reductions in drug use intensity may be a key harm reduction modality for improving clinical outcomes in this population.

KW - Bacterial infection

KW - Injection drug use

KW - PWID with high frequency

KW - PWID with reduced frequency

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U2 - 10.1186/s12954-019-0312-8

DO - 10.1186/s12954-019-0312-8

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JO - Harm Reduction Journal

JF - Harm Reduction Journal

SN - 1477-7517

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