Incidence and treatment costs of severe bacterial infections among people who inject heroin: A cohort study in South London, England

TY - JOUR

T1 - Incidence and treatment costs of severe bacterial infections among people who inject heroin

T2 - A cohort study in South London, England

AU - Lewer, Dan

AU - Hope, Vivian D.

AU - Harris, Magdalena

AU - Kelleher, Michael

AU - Jewell, Amelia

AU - Pritchard, Megan

AU - Strang, John

AU - Morley, Katherine

PY - 2020/7/1

Y1 - 2020/7/1

N2 - Background: People who inject drugs often get bacterial infections. Few longitudinal studies have reported the incidence and treatment costs of these infections. Methods: For a cohort of 2335 people who inject heroin entering treatment for drug dependence between 2006 and 2017 in London, England, we reported the rates of hospitalisation or death with primary causes of cutaneous abscess, cellulitis, phlebitis, septicaemia, osteomyelitis, septic arthritis, endocarditis, or necrotising fasciitis. We compared these rates to the general population. We also used NHS reference costs to calculate the cost of admissions. Results: During a median of 8.0 years of follow-up, 24 % of patients (570/2335) had a severe bacterial infection, most commonly presenting with cutaneous abscesses or cellulitis. Bacterial infections accounted for 13 % of all hospital admissions. The rate was 73 per 1000 person-years (95 % CI 69–77); 50 times the general population, and the rate remained high throughout follow-up. The rate of severe bacterial infections for women was 1.50 (95 % CI 1.32–1.69) times the rate for men. The mean cost per admission was £4980, and we estimate that the annual cost of hospital treatment for people who inject heroin in London is £4.5 million. Conclusions: People who inject heroin have extreme and long-term risk of severe bacterial infections.

AB - Background: People who inject drugs often get bacterial infections. Few longitudinal studies have reported the incidence and treatment costs of these infections. Methods: For a cohort of 2335 people who inject heroin entering treatment for drug dependence between 2006 and 2017 in London, England, we reported the rates of hospitalisation or death with primary causes of cutaneous abscess, cellulitis, phlebitis, septicaemia, osteomyelitis, septic arthritis, endocarditis, or necrotising fasciitis. We compared these rates to the general population. We also used NHS reference costs to calculate the cost of admissions. Results: During a median of 8.0 years of follow-up, 24 % of patients (570/2335) had a severe bacterial infection, most commonly presenting with cutaneous abscesses or cellulitis. Bacterial infections accounted for 13 % of all hospital admissions. The rate was 73 per 1000 person-years (95 % CI 69–77); 50 times the general population, and the rate remained high throughout follow-up. The rate of severe bacterial infections for women was 1.50 (95 % CI 1.32–1.69) times the rate for men. The mean cost per admission was £4980, and we estimate that the annual cost of hospital treatment for people who inject heroin in London is £4.5 million. Conclusions: People who inject heroin have extreme and long-term risk of severe bacterial infections.

KW - Bacterial infections

KW - Drug injection

KW - Heroin

KW - Opiates

UR - http://www.scopus.com/inward/record.url?scp=85084509472&partnerID=8YFLogxK

U2 - 10.1016/j.drugalcdep.2020.108057

DO - 10.1016/j.drugalcdep.2020.108057

M3 - Article

SN - 0376-8716

VL - 212

JO - Drug and alcohol dependence

JF - Drug and alcohol dependence

M1 - 108057

ER -