A Cost Analysis of Hospitalizations for Infections Related to Injection Drug Use at a County Safety-Net Hospital in Miami, Florida

Hansel Tookes, Chanelle Diaz, Hua Li, Rafi Khalid, Susanne Doblecki-Lewis, Hansel Tookes, Chanelle Diaz, Hua Li, Rafi Khalid, Susanne Doblecki-Lewis

Abstract

Background: Infections related to injection drug use are common. Harm reduction strategies such as syringe exchange programs and skin care clinics aim to prevent these infections in injection drug users (IDUs). Syringe exchange programs are currently prohibited by law in Florida. The goal of this study was to estimate the mortality and cost of injection drug use-related bacterial infections over a 12-month period to the county safety-net hospital in Miami, Florida. Additionally, the prevalence of HIV and hepatitis C virus among this cohort of hospitalized IDUs was estimated.

Methods and findings: IDUs discharged from Jackson Memorial Hospital were identified using the International Classification of Diseases, Ninth Revision, codes for illicit drug abuse and endocarditis, bacteremia or sepsis, osteomyelitis and skin and soft tissue infections (SSTIs). 349 IDUs were identified for chart abstraction and 92% were either uninsured or had publicly funded insurance. SSTIs, the most common infection, were reported in 64% of IDUs. HIV seroprevalence was 17%. Seventeen patients (4.9%) died during their hospitalization. The total cost for treatment for injection drug use-related infections to Jackson Memorial Hospital over the 12-month period was $11.4 million.

Conclusions: Injection drug use-related bacterial infections represent a significant morbidity for IDUs in Miami-Dade County and a substantial financial cost to the county hospital. Strategies aimed at reducing risk of infections associated with injection drug use could decrease morbidity and the cost associated with these common, yet preventable infections.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. (A) demonstrates the relationship between…
Fig 1. (A) demonstrates the relationship between the observed frequencies of infectious diagnoses.
Euler diagram. (B) shows the charges per infection type and the proportion of the total charges.

References

    1. Centers for Disease Control and Prevention (CDC). HIV Surveillance Report: Diagnoses of HIV Infection in the United States and Dependent Areas, 2012; vol. 24. Published November 2014. Accessed 2015 Feb 18.
    1. Tempalski B, Lieb S, Cleland CM, Cooper H, Brady JE, Friedman SR. HIV prevalence rates among injection drug users in 96 large US metropolitan areas, 1992–2002. J Urban Health. 2009;86: 132–154. 10.1007/s11524-008-9328-1
    1. Broz D, Wejnert C, Pham HT, DiNenno E, Heffelfinger JD, Cribbin M, et al. HIV infection and risk, prevention, and testing behaviors among injecting drug users—National HIV Behavioral Surveillance System, 20 U.S. cities, 2009. MMWR Surveill Summ. 2014;63: 1–51.
    1. Hall JN. Drug Abuse Trends in Miami-Dade and Broward Counties, South Florida: June 2014. National Institute on Drug Abuse (NIDA) 2014: 6.
    1. Centers for Disease Control and Prevention (CDC). Soft tissue infections among injection drug users—San Francisco, California, 1996–2000. MMWR Morb Mortal Wkly Rep. 2001;50: 381–384.
    1. Simmen HP, Giovanoli P, Battaglia H, Wust J, Meyer VE. Soft tissue infections of the upper extremities with special consideration of abscesses in parenteral drug abusers. A prospective study. J Hand Surg Br. 1995;20: 797–800.
    1. Binswanger IA, Kral AH, Bluthenthal RN, Rybold DJ, Edlin BR. High prevalence of abscesses and cellulitis among community-recruited injection drug users in San Francisco. Clin Infect Dis. 2000;30: 579–581.
    1. Lloyd-Smith E, Kerr T, Hogg RS, Li K, Montaner JS, Wood E. Prevalence and correlates of abscesses among a cohort of injection drug users. Harm Reduct J. 2005;2: 24
    1. Gordon RJ, Lowy FD. Bacterial infections in drug users. N Engl J Med. 2005;353: 1945–1954.
    1. Murphy EL, DeVita D, Liu H, Vittinghoff E, Leung P, Ciccarone DH, et al. Risk factors for skin and soft-tissue abscesses among injection drug users: a case-control study. Clin Infect Dis. 2001;33: 35–40.
    1. Phillips KT, Stein MD. Risk practices associated with bacterial infections among injection drug users in Denver, Colorado. Am J Drug Alcohol Abuse. 2010;36: 92–97. 10.3109/00952991003592311
    1. Kimura AC, Higa JI, Levin RM, Simpson G, Vargas Y, Vugia DJ. Outbreak of necrotizing fasciitis due to Clostridium sordellii among black-tar heroin users. Clin Infect Dis. 2004;38: e87–91.
    1. Lonergan S, Rodriguez RM, Schaulis M, Navaran P. A case series of patients with black tar heroin-associated necrotizing fasciitis. J Emerg Med. 2004;26: 47–50.
    1. Hyshka E, Strathdee S, Wood E, Kerr T. Needle exchange and the HIV epidemic in Vancouver: lessons learned from 15 years of research. Int J Drug Policy. 2012;23: 261–270. 10.1016/j.drugpo.2012.03.006
    1. Lloyd-Smith E, Wood E, Zhang R, Tyndall MW, Montaner JS, Kerr T. Risk factors for developing a cutaneous injection-related infection among injection drug users: a cohort study. BMC Public Health. 2008;8: 405-2458-8-405.
    1. Marks M, Pollock E, Armstrong M, Morris-Jones S, Kidd M, Gothard P, et al. Needles and the damage done: reasons for admission and financial costs associated with injecting drug use in a Central London Teaching Hospital. J Infect. 2013;66: 95–102. 10.1016/j.jinf.2012.10.004
    1. Sweeney R, Conroy AB, Dwyer R, Aitken CK. The economic burden to the public health system of treating non-viral injecting-related injury and disease in Australia (a cost of illness analysis). Aust N Z J Public Health. 2009;33: 352–357. 10.1111/j.1753-6405.2009.00407.x
    1. Spijkerman IJ, van Ameijden EJ, Mientjes GH, Coutinho RA, van den Hoek A. Human immunodeficiency virus infection and other risk factors for skin abscesses and endocarditis among injection drug users. J Clin Epidemiol. 1996;49: 1149–1154.
    1. Frontera JA, Gradon JD. Right-side endocarditis in injection drug users: review of proposed mechanisms of pathogenesis. Clin Infect Dis. 2000;30: 374–379.
    1. Jain V, Yang MH, Kovacicova-Lezcano G, Juhle LS, Bolger AF, Winston LG. Infective endocarditis in an urban medical center: association of individual drugs with valvular involvement. J Infect. 2008;57: 132–138. 10.1016/j.jinf.2008.05.008
    1. Saydain G, Singh J, Dalal B, Yoo W, Levine DP. Outcome of patients with injection drug use-associated endocarditis admitted to an intensive care unit. J Crit Care. 2010;25: 248–253. 10.1016/j.jcrc.2009.09.007
    1. Tunkel AR, Pradhan SK. Central nervous system infections in injection drug users. Infect Dis Clin North Am. 2002;16: 589–605.
    1. Heinzerling KG, Etzioni DA, Hurley B, Holtom P, Bluthenthal RN, Asch SM. Hospital utilization for injection drug use-related soft tissue infections in urban versus rural counties in California. J Urban Health. 2006;83: 176–181.
    1. Palepu A, Tyndall MW, Leon H, Muller J, O'Shaughnessy MV, Schechter MT, et al. Hospital utilization and costs in a cohort of injection drug users. CMAJ. 2001;165: 415–420.
    1. Stein MD, Sobota M. Injection drug users: hospital care and charges. Drug Alcohol Depend. 2001;64: 117–120.
    1. Takahashi TA, Maciejewski ML, Bradley K. US hospitalizations and costs for illicit drug users with soft tissue infections. J Behav Health Serv Res. 2010;37: 508–518. 10.1007/s11414-009-9177-z
    1. Gebo KA, Fleishman JA, Moore RD. Hospitalizations for metabolic conditions, opportunistic infections, and injection drug use among HIV patients: trends between 1996 and 2000 in 12 states. J Acquir Immune Defic Syndr. 2005;40: 609–616.
    1. Cooper HL, Brady JE, Ciccarone D, Tempalski B, Gostnell K, Friedman SR. Nationwide increase in the number of hospitalizations for illicit injection drug use-related infective endocarditis. Clin Infect Dis. 2007;45: 1200–1203.
    1. Micallef L, Rodgers P. eulerAPE: drawing area-proportional 3-Venn diagrams using ellipses. PLoS One. 2014;9: e101717 10.1371/journal.pone.0101717
    1. American Hospital Directory. Jackson Memorial Hospital Facility Profile. 2015. Available: . Accessed 2015 Feb 18.
    1. U.S. Census Bureau. Miami-Dade County QuickFacts. 2013. Available: Accessed 2015 Feb 18.
    1. Binswanger IA, Takahashi TA, Bradley K, Dellit TH, Benton KL, Merrill JO. Drug users seeking emergency care for soft tissue infection at high risk for subsequent hospitalization and death. J Stud Alcohol Drugs. 2008;69: 924–932.
    1. Chen JL, Fullerton KE, Flynn NM. Necrotizing fasciitis associated with injection drug use. Clin Infect Dis. 2001;33: 6–15.
    1. Ebright JR, Pieper B. Skin and soft tissue infections in injection drug users. Infect Dis Clin North Am. 2002;16: 697–712.
    1. Del Giudice P. Cutaneous complications of intravenous drug abuse. Br J Dermatol. 2004;150: 1–10.
    1. Kak V, Chandrasekar PH. Bone and joint infections in injection drug users. Infect Dis Clin North Am. 2002;16: 681–695.
    1. Takahashi TA, Baernstein A, Binswanger I, Bradley K, Merrill JO. Predictors of hospitalization for injection drug users seeking care for soft tissue infections. J Gen Intern Med. 2007;22: 382–388.
    1. Harris HW, Young DM. Care of injection drug users with soft tissue infections in San Francisco, California. Arch Surg. 2002;137: 1217–1222.
    1. Belani HK, Muennig PA. Cost-effectiveness of Needle and Syringe Exchange for the Prevention of HIV in New York City. J HIV/AIDS& Social Services. 2008;7: 229.
    1. Gold M, Gafni A, Nelligan P, Millson P. Needle exchange programs: an economic evaluation of a local experience. CMAJ. 1997;157: 255–262.
    1. Holtgrave DR, Pinkerton SD, Jones TS, Lurie P, Vlahov D. Cost and cost-effectiveness of increasing access to sterile syringes and needles as an HIV prevention intervention in the United States. J Acquir Immune Defic Syndr Hum Retrovirol. 1998;18 Suppl 1: S133–8.
    1. Kwon JA, Anderson J, Kerr CC, Thein HH, Zhang L, Iversen J, et al. Estimating the cost-effectiveness of needle-syringe programs in Australia. AIDS. 2012;26: 2201–2210. 10.1097/QAD.0b013e3283578b5d
    1. Lurie P, Gorsky R, Jones TS, Shomphe L. An economic analysis of needle exchange and pharmacy-based programs to increase sterile syringe availability for injection drug users. J Acquir Immune Defic Syndr Hum Retrovirol. 1998;18 Suppl 1: S126–32.
    1. Department of Health. Agency Legislative Bill Analysis (HB 735). 2013. Available from the Florida Department of Health Bureau of HIV/AIDS and Hepatitis upon request.
    1. Florida Senate Committee on Health Policy. Bill Analysis and Fiscal Impact Statement. 2014. Available: . Accessed 2015 Feb 18.
    1. Tookes HE, Kral AH, Wenger LD, Cardenas GA, Martinez AN, Sherman RL, et al. A comparison of syringe disposal practices among injection drug users in a city with versus a city without needle and syringe programs. Drug Alcohol Depend. 2012;123: 255–259. 10.1016/j.drugalcdep.2011.12.001

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner