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Evaluating Differences in Opioid and Stimulant Use-associated Infectious Disease Hospitalizations in Florida, 2016–2017

Serota, David P, Bartholomew, Tyler S, Tookes, Hansel E·2021·Clinical Infectious Diseases
DOI 10.1093/cid/ciaa1278PMC PMC8492144
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Abstract

Background: The opioid epidemic has led to increases in injection drug use (IDU)-associated infectious diseases; however, little is known about how more recent increases in stimulant use have affected the incidence and outcomes of hospitalizations for infections among people who inject drugs (PWID). Methods: All hospitalizations of PWID for IDU-associated infections in Florida were identified using administrative diagnostic codes and were grouped by substance used (opioids, stimulants, or both) and site of infection. We evaluated the association between substance used and the outcomes: patient-directed discharge (PDD, or “against medical advice”) and in-hospital mortality. Results: There were 22 856 hospitalizations for infections among PWID. Opioid use was present in 73%, any stimulants in 43%, and stimulants-only in 27%. Skin and soft tissue infection was present in 50%, sepsis/bacteremia in 52%, osteomyelitis in 10%, and endocarditis in 10%. PWID using opioids/stimulants were youngest, most uninsured, and had the highest rates of endocarditis (16%) and hepatitis C (44%). Additionally, 25% of patients with opioid/stimulant use had PDD versus 12% for those using opioids-only. In adjusted models, opioid/stimulant use was associated with PDD compared to opioid-only use (aRR 1.28, 95% CI 1.17–1.40). Younger age and endocarditis were also associated with PDD. Compared to opioid-only use, stimulant-only use had higher risk of in-hospital mortality (aRR 1.26, 95% CI 1.03–1.46). Conclusions: While opioid use contributed to most IDU-associated infections, many hospitalizations also involved stimulants. Increasing access to harm reduction interventions could help prevent these infections, while further research on the acute management of stimulant use disorder-associated infections is needed.

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Figure 1. Flow diagram of IDU-associated infections in Florida. Abbreviation: IDU, injection drug use.
Figure 1. Flow diagram of IDU-associated infections in Florida. Abbreviation: IDU, injection drug use.CC BY-NC-ND · PubMed Central
Figure 2. Euler diagrams of infection distribution among people who inject drugs hospitalized in Florida, stratified by substance used. A, Opioid/Stimulant, B, Stimulant-only, and C, Opioid-only use. Ellipses represent the proportional frequency of each infection diagnosis with areas of overlap representing people with multiple infection diagnoses. Cases with all 4 diagnoses present are not graphically represented, their frequency is: opioid-only 25, stimulant-only 6, opioid/stimulant 17. Abbreviations: Bact/sepsis, bacteremia/sepsis; endo, endocarditis; osteo, osteomyelitis; SSTI, skin and soft tissue infection.
Figure 2. Euler diagrams of infection distribution among people who inject drugs hospitalized in Florida, stratified by substance used. A, Opioid/Stimulant, B, Stimulant-only, and C, Opioid-only use. Ellipses represent the proportional frequency of each infection diagnosis with areas of overlap representing people with multiple infection diagnoses. Cases with all 4 diagnoses present are not graphically represented, their frequency is: opioid-only 25, stimulant-only 6, opioid/stimulant 17. Abbreviations: Bact/sepsis, bacteremia/sepsis; endo, endocarditis; osteo, osteomyelitis; SSTI, skin and soft tissue infection.CC BY-NC-ND · PubMed Central

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Research works printed but not linked: 38

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Metadata

Authors
Serota, D. P., Bartholomew, T. S., & Tookes, H. E.
Affiliations
  • Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
  • Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
ORCID
Serota, David P
Venue
Clinical Infectious Diseases
Publisher
Oxford University Press (OUP)
Published
2020-09-04
Volume
73
Issue
7
Pages
e1649-e1657
ISSN
  • 1058-4838
  • 1537-6591
DOI
10.1093/cid/ciaa1278
PMC
PMC8492144
Cited by
38
References
3
Language
en
Licence
creativecommons.org/licenses/by-nc-nd/4.0/ (vor)
Funders
National Institutes of Health (P30CA240139)

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CoChat. (2026). Citation check: Evaluating Differences in Opioid and Stimulant Use-associated Infectious Disease Hospitalizations in Florida, 2016–2017. https://app.cochat.ai/papers/10.1093/cid/ciaa1278
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Serota, D. P., Bartholomew, T. S., & Tookes, H. E. (2021). Evaluating Differences in Opioid and Stimulant Use-associated Infectious Disease Hospitalizations in Florida, 2016–2017. Clinical Infectious Diseases. https://doi.org/10.1093/cid/ciaa1278