Risk factors for multiple skin abscesses among community-recruited people who inject drugs in Los Angeles, CA, and Denver, CO: a cross-sectional study.

Abstract

Introduction: Skin abscesses are one of the most common infections among people who inject drugs (PWID).

Objective: To examine factors associated with the frequency of abscesses in the previous 3 months among PWID.

Design: We conducted a cross-sectional analysis of baseline data from a prospective longitudinal cohort of PWID.

Methods: Between April 2021 and November 2022, PWID were recruited from community settings in Los Angeles, CA, and Denver, CO. Participants completed an interview covering sociodemographic, drug use, and related risk behaviors. Participants were asked if they had abscesses in the last 3 months. Those reporting "yes" quantified the number of abscesses. Responses were classified as None, 1, or 2 or more. We used bivariate analysis and multi-nominal regression to examine factors associated with the frequency of abscesses.

Results: Among participants (n = 472), 62% reported no abscesses, 16% reported 1 abscess, and 22% reported 2+ abscesses in the last 3 months. Compared to participants with no abscess, 1 abscess was associated with receiving buprenorphine treatment (adjusted odds ratio (AOR) = 3.27; 95% CI = 1.58, 6.78), being injected by another person (AOR = 3.06; 95% CI = 1.72, 5.45), injecting 3+ times a day (as compared to less than daily, AOR = 2.92; 95% CI = 1.28, 6.65), licking syringe prior to injection (AOR = 1.96; 95% CI = 1.03, 3.74), and being Latino (AOR = 0.25; 95% CI = 0.12, 0.54). Having 2+ abscess was associated with daily heroin use (AOR = 2.35; 95% CI = 1.26, 4.39), being injected by another person (AOR = 1.92; 95% CI = 1.16, 3.18), daily methamphetamines use (0.50; 95% CI = 0.30, 0.83) and those reporting 10+ rushed injection (as compared to none, AOR = 1.85, 95% CI = 1.04, 3.29) in the last 3 months.

Conclusion: Our findings underscore a multi-level approach to reducing abscesses in this population. Increased education around safe injection practices, institutional interventions-that is, addressing healthcare stigmatization and expanding clinical harm reduction-as well as structural interventions (safe supply, overdose prevention programs, housing) should be considered.