High rates of abscesses and chronic wounds in community-recruited injection drug users and associated risk factors.

OBJECTIVES: Abscesses and chronic wounds are common among injection drug users (IDUs) though chronic wounds have been understudied. We assessed the risk factors associated with both acute and chronic wounds within a community-based population of IDUs frequenting the Baltimore City Needle Exchange Program (BNEP). METHODS: We performed a cross-sectional study of BNEP clients aged 18 years or more who completed an in-person survey regarding active or prior wounds including abscesses (duration <8 weeks) and chronic wounds (duration ≥8 weeks), injection practices, and skin care. Factors associated with wounds were analyzed using univariate and multivariate logistic regressions. RESULTS: Of the 152 participants, 63.2% were men, 49.3% were white, 44.7% were African American, 34.9% had any type of current wound, 17.8% had an active abscess, and 19.7% had a current chronic wound. Abscesses were more common in women (odds ratio [OR], 2.56; 95% confidence interval [CI], 1.10-5.97) and those reporting skin-popping (OR, 5.38; 95% CI, 1.85-15.67). In a multivariate model, risk factors for an abscess included injecting with a family member/partner (adjusted OR [AOR], 4.06; 95% CI, 0.99-16.58). In a multivariable analysis of current chronic wounds, cleaning skin with alcohol before injection was protective (AOR, 0.061; 95% CI, 0.0064-0.58). CONCLUSIONS: Abscesses and chronic wounds were prevalent among a sample of IDUs in Baltimore. Abscesses were associated with injection practices, and chronic wounds seemed linked to varying skin and tool cleaning practices. There is a pressing need for wound-related education and treatment efforts among IDUs who are at greatest risk for skin-related morbidity.

Self-care and risk reduction habits in older injection drug users with chronic wounds: a cross-sectional study.

BACKGROUND: We surveyed a population of injection drug users (IDUs) frequenting the mobile Baltimore City Needle Exchange Program (BNEP) to investigate self-care factors associated with chronic wounds, a significant cause of morbidity especially among older IDUs. METHODS: Participants ≥18 years old completed a survey regarding chronic wounds (duration ≥8 weeks), injection and hygiene practices. Study staff visually verified the presence of wounds. Participants were categorized into four groups by age and wound status. Factors associated with the presence of chronic wounds in participants ≥45 years were analyzed using logistic regression. RESULTS: Of the 152 participants, 19.7% had a chronic wound. Of those with chronic wounds, 18 were ≥45 years old (60.0%). Individuals ≥45 years old with chronic wounds were more likely to be enrolled in a drug treatment program (Odds ratio (OR) 3.4, 95% Confidence interval (CI) 1.0-10.8) and less likely to use cigarette filters when drawing up prepared drug (OR 0.2, 95% CI 0.03-0.7) compared to the same age group without chronic wounds. Compared to individuals <45 years old without chronic wounds, individuals ≥45 with a chronic wound were more likely to report cleaning reused needles with bleach (OR 10.7, 95% CI 1.2-93.9) and to use the clinic, rather than an emergency room, as a primary source of medical care (OR 3.4, 95% CI 1.1-10.4). CONCLUSIONS: Older IDUs with chronic wounds have different, and perhaps less risky, injection and hygiene behaviors than their peers and younger IDUs without wounds in Baltimore City. Because of these differences, older IDUs with wounds may be more receptive to community-based healthcare and substance abuse treatment messages.

Comparison of chronic wound culture techniques: swab versus curetted tissue for microbial recovery.

Health-care professionals are increasingly relying on wound cultures as part of their clinical assessment. Tissue viability nurses in the UK use wound swabbing as the standard specimen-taking technique, but others are used globally and there is no worldwide standard. This study compares two wound culture techniques in uninfected chronic wounds of active and former injection drug users seeking care through a civic needle exchange mobile wound clinic. For each wound, two sampling approaches were applied during the same visit: swab culture and curetted tissue culture. A total of 12 chronic wounds were assessed among 9 patients, including 19 swab cultures and 19 tissue cultures. These 38 cultures grew a total of 157 individually identified bacterial organisms, including 27 anaerobic organisms (17.2%), 63 Gram-positive species (40.1%), and 67 Gram-negative species (42.7%). The swab technique yielded a greater percentage recovery rate of anaerobic (55.6%), Gram-positive (52.4%), and all species (51.6%) compared to tissue culture (P>0.05). Recovery of common wound species, such as methicillin-sensitive Staphylococcus aureus, methicillin-resistant Staphylococcus aureus, and Pseudomonas aeruginosa was the same using either method (50.0%). Swab and curetted tissue cultures yielded similar recovery rates for common wound bacteria. Therefore, swabs (including a vacuum transport container) may offer an advantage in the recovery of anaerobes. Based upon this analysis, the swabbased culture method for chronic wounds currently used in the UK is reasonable.

Wounds on wheels: implementing a specialized wound clinic within an established syringe exchange program in Baltimore, Maryland.

People who inject drugs (PWID) experience a high incidence of abscesses and chronic wounds. However, many PWID delay seeking care for their wounds. In 2012, the Baltimore Needle Exchange Program (BNEP) in Baltimore, Maryland, partnered with the Johns Hopkins Wound Healing Center to establish a mobile BNEP Wound Clinic. This clinic provided specialized wound care for BNEP patients. In sixteen months, the clinic treated 78 unique patients during 172 visits overall. On average, each visit cost the program $146.45, which was substantially less than clinic-based treatment. This program demonstrates that specialized wound care can be effectively provided through mobile outreach. A community-based service delivery approach might serve as a model for local health departments looking to improve the health of PWID.

Toxoplasma gondii salvages sphingolipids from the host Golgi through the rerouting of selected Rab vesicles to the parasitophorous vacuole.

The obligate intracellular protozoan Toxoplasma gondii actively invades mammalian cells and, upon entry, forms its own membrane-bound compartment, named the parasitophorous vacuole (PV). Within the PV, the parasite replicates and scavenges nutrients, including lipids, from host organelles. Although T. gondii can synthesize sphingolipids de novo, it also scavenges these lipids from the host Golgi. How the parasite obtains sphingolipids from the Golgi remains unclear, as the PV avoids fusion with host organelles. In this study, we explore the host Golgi-PV interaction and evaluate the importance of host-derived sphingolipids for parasite growth. We demonstrate that the PV preferentially localizes near the host Golgi early during infection and remains closely associated with this organelle throughout infection. The parasite subverts the structure of the host Golgi, resulting in its fragmentation into numerous ministacks, which surround the PV, and hijacks host Golgi-derived vesicles within the PV. These vesicles, marked with Rab14, Rab30, or Rab43, colocalize with host-derived sphingolipids in the vacuolar space. Scavenged sphingolipids contribute to parasite replication since alterations in host sphingolipid metabolism are detrimental for the parasite's growth. Thus our results reveal that T. gondii relies on host-derived sphingolipids for its development and scavenges these lipids via Golgi-derived vesicles.