Skin and Soft Tissue Infections in the Injection Drug Users

注射藥癮患者的皮膚軟組織感染

張惇皓(Dun-Hao Chang) ； 張哲瑋(Che-Wei Chang) ； 陳右昇(Yo-Sheng Chen) ； 謝綺瀅(Chi-Ying Hsieh) ； 阮廷倫(Ting-Luen Roan) ； 游彥辰(Yen-Chen Yu) ； 柯安達(An-Ta Ko) ； 張克中(Ke-Chung Chang)

《臺灣整形外科醫學會雜誌》 29卷1期 (2020/03) Pp. 24-37

摘要

Background: Skin and soft tissue infections (SSTIs) are commonly observed among injection drug users (IDUs). The severity and extent of SSTIs in IDUs are diverse. Some patients have benign and superficial infections and some others have complex and invasive infections. Only few published studies have addressed the issue and data on SSTIs are lacking for Asian IDUs. Aim and Objectives: To retrospectively assess the epidemiologic data of IDUs admitted for SSTIs and investigate the differences between patients with superficial and invasive SSTIs. Materials and Methods: We reviewed the clinical records of IDUs with SSTIs hospitalized in the Far Eastern Memorial Hospital (FEMH) from January 2005 to the end of December 2017. The patients with septic arthritis or implant related infections were excluded. We classified all patients into superficial or invasive infection group, based on clinical, radiological, and surgical findings. The patients' demographics, underlying diseases, infection sites, laboratory and microbiological results, surgical courses, clinical outcomes and complications were collected and analyzed. Results: Forty-seven IDU patients [36 men and 11 women, mean age, 43.6 (24-67) years] were admitted for SSTIs. There were 16 patients diagnosed with cellulitis, 3 with superficial abscess, 10 with deep abscess, 15 with necrotizing fasciitis and 3 with other necrotizing soft tissue infections. The superficial infection group comprised of 19 patients, whereas the invasive infection group comprised 28 patients. Thirteen patients had type 2 diabetes mellitus (DM) with a higher probability to have invasive infections than superficial infections (39.3% vs. 10.5%, p = 0.046). Among the invasive infection group, one patient died and three patients had vascular complications. 46.2% of the invasive infection patients had polymicrobial pathogens. The patients with invasive infections needed more debridements (2.46 ± 2.43 VS 0.95 ± 1.08 VS, p =0.001), skin grafts, or flaps for wound closure (28.6% VS 5.3%, p=0.06) and had longer hospital stay durations (22.8 ± 17.7 VS 12.1 ± 7.2 days, p=0.016). Conclusion: IDUs with diabetes mellitus showed a higher risk of invasive infections than those without diabetes mellitus. The patients with invasive infection required more debridements and reconstruction procedures and had a higher rate of complications. Thus, early diagnosis with image study, adequate antibiotics coverage and timely surgical intervention can lead to positive outcomes.

關鍵字

skin infection ； soft tissue infection ； injection drug users

並列摘要

背景：皮膚軟組織感染常見於注射藥癮患者。這些患者疾病表現的嚴重度和範圍差異性很大。有些病患的感染較為表淺輕微，有些病患的感染則較深且複雜。過去只有少數的研究針對此一議題，而缺乏亞洲族群的相關報告。目的及目標：回溯性的研究注射藥癮患者皮膚軟組織感染的流行病學，並分析表淺感染和深部感染病患的差異。材料及方法：我們回溯了亞東紀念醫院2005年1月至2017年12月期間的住院病患資料，並擷取了注射藥癮患者皮膚軟組織感染的案例。病患患有感染性關節炎或植入物相關的感染則被排除。依照臨床表現、影像學及手術發現，病患被分為表淺及深部感染兩個族群。我們蒐集並分析病患的基本資料、患部、實驗室和微生物檢查報告、手術項目、臨床預後及併發症。結果：於研究期間，共47位注射藥癮患者因皮膚軟組織感染而住院，包含36位男性11位女性，平均年齡43.6歲。16位病患診斷為蜂窩性組織炎和3位表淺膿瘍病患為表淺感染組，共19位病患。10位病患為深部膿瘍和15位壞死性筋膜炎及3位其他壞死性軟組織感染共28位病患，為深部感染組。13位病患有第二型糖尿病且有較高的機會得到深部感染（39.3% vs. 10.5%, p=0.046）。於深部感染族群中，一位病患死亡而有三位有血管相關的併發症。46.2%深部感染的病患為多重細菌感染。與淺部感染相比，深部感染病患需要較多次的清創（2.46±2.43 VS 0.95±1.08 VS, p=0.001），有較高的比例需要植皮或皮瓣手術以關閉傷口（28.6%VS5.3%, p=0.06）且住院天數較長（22.8±17.7 VS 12.1±7.2 days, p=0.016）。結論：注射藥癮病患患有糖尿病者較易有深部感染的風險。深部感染的病患需要較多次的清創和重建手術，而且產生併發症的機率較高。影像學早期診斷、適當的抗生素使用和即時的手術介入可達到較佳的預後。