Skin and Soft Tissue Infections and Vascular Disease among Drug Users, England

To the Editor: The injecting of illicit drugs is associated with skin and soft tissue infections (SSTIs) and vas-cular disease (1–3). These conditions include the development of cutaneous abscess and cellulitis at injection sites, from subcutaneous or intramuscular injecting, known as skin and muscle popping, and intravenous injecting (1–3). Intravenous injection is associated with phlebitis or thrombophle-bitis, in which the vein may become infected (4). Inadvertent arterial injection , particularly when attempting to inject into the femoral vein, that is, " groin injecting, " may cause arterial pseudoaneurysm (4,5). Drug-related conditions form a major part of the workload of some hospital emergency departments in the United Kingdom and elsewhere (1– 3,6). We aimed to identify emerging trends in hospital admission for SSTIs and vascular disease arising from drug use and, specifi cally, where these may have occurred after injection of the femoral vein. We extracted hospital admission data for drug users 15–44 years of age for the fi scal years April 1, 1997–March 31, 2004, from the UK Department of Health, hospital episode statistics (HES) database. Using the International Classifi cation of Diseases , 10th revision (ICD-10) codes F11–16, F18, and, F19, we identifi ed drug users by a record in any diagnostic fi eld of mental and behavioral disorders due to psychoactive substances, excluding alcohol and tobacco. We identifi ed the primary diagnosis on admission and whether the admission was as an emergency. Over the study period, admissions of drug users for cutaneous abscess, L020–L029; cellulitis, L030–L039; and phlebitis or thrombophlebitis, I801–I809; increased substantially (online Appendix Figure, available from; the largest percentage increase was for phlebitis or thrombophlebitis of the femoral vein, I801, from 60 to 533 (788%). Increases were also observed for aneurysm or pseudoaneurysm of an artery of a lower limb, I724, from 9 to 62 (589%), cutaneous abscess of trunk or groin, L022, from 92 to 613 (566%), cellulitis of trunk or groin, L033, from 13 to 74 (469%), and, phlebitis or thrombophlebitis of deep vessels of the lower limb other than the femoral vein, I802, from 269 to 1,314 (388%). No national data exist for the prevalence of injection drug use in England (7). Although the number of opiate injecting drug users may have increased in the 1990s (8), the rapid and substantial increase in admissions for SSTIs and vascular disease suggests that this has not resulted from an increase in the injecting population alone. …