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PWID 16 times likelier to develop invasive MRSA infections
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People who inject drugs are around 16 times more likely to develop an invasive MRSA infection compared with others, with cases in this population rising from 4.1% to 9.2% from 2011 to 2016, according to findings published in MMWR.
Kelly A. Jackson, MPH, invasive Staphylococcus aureus surveillance coordinator in the CDC’s Division of Healthcare Quality Promotion, and colleagues analyzed data collected through the Healthcare-Associated Infections/Community Interface component of the CDC’s Emerging Infections Program to measure how the opioid epidemic in the United States affected invasive MRSA infections from 2005 through 2016. They noted that in areas where the opioid epidemic is expanding, invasive bacterial infections, including endocarditis, osteomyelitis and skin and soft tissue infections, have increased.
In the study, isolation of MRSA from a normally sterile site, including blood, cerebrospinal fluid and bone, from a surveillance area resident was used to define a case of invasive MRSA. Jackson and colleagues compared demographics and risk factors for cases of invasive MRSA in people who injected drugs (PWID) from 2005 to 2010 with cases from 2011 to 2016.
There were 2,093 invasive MRSA cases in PWID among 39,050 total invasive MRSA cases reported during 2005 to 2016 at six sites. In 2011, people aged at least 13 years who injected drugs during the previous year had an estimated rate of invasive MRSA of 472.2 per 100,000, whereas the rate for people of the same age who did not inject drugs was 29 per 100,000 (RR = 16.3; 95% CI, 15.7-16.8).
Between 2005 and 2010 there was a decline in the proportion of invasive MRSA cases among PWID (6.4% to 3.5%; P < .05); however, the percentage increased to 9.2% in 2016 (P < .05). The researchers found that nonsterile injection drug use was often associated with these infections.
Cases of invasive MRSA occurring in PWID between 2011 to 2016 were more likely to occur in whites (OR = 1.7; 95% CI, 1.4-2.0) and be community associated (OR = 1.3; 95% CI, 1.1-1.6) compared with cases from 2005 to 2010. The proportion of invasive MRSA cases approximately doubled among PWID in some counties in Connecticut, Georgia, Minnesota and Tennessee, the researchers said.
“In six sites, invasive MRSA infections disproportionately affected person who inject drugs,” Jackson and colleagues wrote. “MRSA infections that occurred among persons who inject drugs were those frequently associated with nonsterile injection drug use; demographic shifts in population of invasive MRSA infections among injection drug users mirror those observed in the ongoing opioid epidemic, such as an increased proportion of cases among whites.”
The researchers noted the importance of public health interventions, “including prevention of opioid misuse, providing medication-assisted treatment, syringe services programs, and education on safer injection practices to prevent infections from skin flora.” – by Bruce Thiel
Reference:
Jackson KA, et al. MMWR Morb Mortal Wkly Rep. 2018;doi:10.15585/mmwr.mm6722a2.
Disclosure: Jackson reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.