Epidemiology

During the last decade, there has been an increasing awareness of the bacterial flora colonizing injection sites that may potentially lead to life-threatening infection (48). In 1997, a sudden increase in needle abscesses caused by a clonal strain of Group A Streptococcus was reported among hospitalized IDUs in Berne, Switzerland (49). A recent UK study showed that the predominant isolate is S. aureus, with Streptococcus species forming just under one-fifth (50% P-hemolytic streptococci) (50). There have also been reports of both nonsporing and sporing anerobes (e.g., Bacteroides and Clostridia species, including Clostridia botulinum) (51,52).

In particular, in 2000, laboratories in Glasgow were reporting isolates of Clostridium novyi among IDUs with serious unexplained illness. By June 12, 2000, a total of 42 cases (18 definite and 24 probable) had been reported. A definite case was defined as an IDU with both severe local and systemic inflammatory reactions. A probable case was defined as an IDU who presented to the hospital with an abscess or other significant inflammation at an injecting site and had either a severe inflammatory process at or around an injection site or a severe systemic reaction with multiorgan failure and a high white cell count (53).

In the United Kingdom, the presence of C. botulinum in infected injection sites is a relatively new phenomenon. Until the end of 1999, there were no cases reported to the Public Health Leadership Society. Since then, the number has increased, with a total of 13 cases in the United Kingdom and Ireland being reported since the beginning of 2002. It is believed that these cases are associated with contaminated batches of heroin. Simultaneous injection of cocaine increases the risk by encouraging anerobic conditions. Anerobic flora in wounds may have serious consequences for the detainee, but the risk of transmission to staff is virtually nonexistent.

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