Rates of hospitalizations for serious bacterial infections among people with substance use disease are increasing, especially in younger populations, according to study published in Clinical Infectious Diseases.

In this retrospective cohort study, researchers evaluated trends in the rates of primary infective endocarditis, central nervous system (CNS) abscess, osteomyelitis, and skin and soft tissue infection (SSTI) hospitalizations with secondary diagnoses of substance use disease. They analyzed these 4 groups separately, using ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) and ICD-10-CM diagnostic codes from the Premier Healthcare Database, a comprehensive electronic healthcare database comprising approximately 800 private and academic hospitals that represent approximately 20% of inpatient discharges in the United States.

Between 2012 and 2017, although the overall rates of hospitalizations for infective endocarditis, CNS abscess, osteomyelitis, and SSTI remained stable or decreased, rates of hospitalizations for these 4 infections related to a substance use disease diagnosis increased significantly. Among all age groups, the rate of hospitalizations with substance use disease increased from 1.1 to 2.1 per 100,000 persons for infective endocarditis, 1.4 to 2.4 per 100,000 persons for osteomyelitis, 0.5 to 0.9 per 100,000 persons for CNS abscesses, and 24.4 to 32.9 per 100,000 persons for SSTIs.

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Among patients aged 18 to 44 years, the rate of hospitalizations with infective endocarditis and substance use disease increased approximately 2-fold, going from 1.6 per 100,000 persons in 2012 to 3.6 per 100,000 persons in 2017.

Compared with non-substance-use disease-related hospitalizations, among all infection hospitalizations except SSTI, mean length of stay and median costs were higher in hospitalizations with substance use disease diagnoses.

In addition, among all infective endocarditis hospitalizations with substance use disease, 50.3% had a positive culture for Staphylococcus aureus compared with 19.4% of infective endocarditis hospitalizations without substance use disease. Among all positive S aureus cultures, 45% were methicillin-resistant.

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Findings from this study “highlight an important correlate of the ongoing opioid crisis and indicate the threat posed to recent progress in reducing the impact of invasive bacterial diseases such as S aureus infection,” noted the researchers. “Interventions and health communications aimed at reducing the risk of bacterial infections as a complication of substance misuse should be added to preventive care for persons with [substance use disease],” they concluded.


Mccarthy NL, Baggs J, See I, et al. Bacterial infections associated with substance use disorders, large cohort of United States hospitals, 2012-2017 [published online January 7, 2020]. Clin Infect Dis. doi:10.1093/cid/ciaa008