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Open Access Research article

Determinants of hospitalization for a cutaneous injection-related infection among injection drug users: a cohort study

Elisa Lloyd-Smith12, Evan Wood123, Ruth Zhang12, Mark W Tyndall12, Sam Sheps2, Julio SG Montaner123 and Thomas Kerr123*

Author Affiliations

1 British Columbia Centre for Excellence in HIV/AIDS, Providence Health Care, 608-1081 Burrard Street, Vancouver, V6Z 1Y6, Canada

2 School of Public and Population Health, University of British Columbia, 2206 East Mall, Vancouver, V6T 1Z3, Canada

3 Department of Medicine, University of British Columbia, 10203-2275 Laurel Street, Vancouver, V5Z 1M9

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BMC Public Health 2010, 10:327  doi:10.1186/1471-2458-10-327

Published: 9 June 2010

Abstract

Background

Cutaneous injection-related infections (CIRI) are a primary reason individuals who inject drugs (IDU) are hospitalized. The objective of this study was to investigate determinants of hospitalization for a CIRI or related infectious complication among a cohort of supervised injection facility (SIF) users.

Methods

From 1 January 1 2004 until 31 January 2008, using Cox proportional hazard regression, we examined determinants of hospitalization for a CIRI or related infectious complication (based on ICD 10 codes) among 1083 IDU recruited from within the SIF. Length of stay in hospital and cost estimates, based on a fully-allocated costing model, was also evaluated.

Results

Among hospital admissions, 49% were due to a CIRI or related infectious complication. The incidence density for hospitalization for a CIRI or related infectious complication was 6.07 per 100 person-years (95% confidence intervals [CI]: 4.96 - 7.36). In the adjusted Cox proportional hazard model, being HIV positive (adjusted hazard ratio [AHR] = 1.79 [95% CI: 1.17 - 2.76]) and being referred to the hospital by a nurse at the SIF (AHR = 5.49 [95% CI: 3.48 - 8.67]) were associated with increased hospitalization. Length of stay in hospital was significantly shorter among participants referred to the hospital by a nurse at the SIF when compared to those who were not referred (4 days [interquartile range {IQR}: 2-7] versus 12 days [IQR: 5-33]) even after adjustment for confounders (p = 0.001).

Conclusions

A strong predictor of hospitalization for a CIRI or related infectious complication was being referred to the hospital by a nurse from the SIF. This finding indicates that nurses not only facilitate hospital utilization but may provide early intervention that prevents lengthy and expensive hospital visits for a CIRI or related infectious complication.