title: HIV seropositivity predicts longer duration of stay and rehospitalization among nonbacteremic febrile injection drug users with skin and soft tissue infections.
abstract: BACKGROUND
  Skin/soft tissue infections (SSTIs) are the leading cause of hospital admissions among injection drug users (IDUs).
  
  
  METHODS
  We performed a retrospective investigation to determine the epidemiology of SSTIs (ie, cellulitis and/or abscesses) in febrile IDUs, with a focus on bacteriology and potential predictors of increased health care utilization measured by longer length of stay and rehospitalization. Subjects were drawn from a cohort of febrile IDUs presenting to an inner-city emergency department from 1998 to 2004.
  
  
  RESULTS
  Of the 295 febrile IDUs with SSTIs, specific discharge diagnoses were cellulitis only (n = 143, 48.5%), abscesses only (n = 113, 38.3%), and both (n = 39, 13.2%). Documented HIV infection rate was 28%. Of note, 10 subjects were newly diagnosed with HIV infection during their visits. Staphylococcus aureus was the leading pathogen, and increasing rates of methicillin-resistant S. aureus emerged over time (before 2001: 4%, 2001-2004: 56%, P < 0.01). HIV seropositivity predicted rehospitalization within 90 days [adjusted hazard ratios and 95% confidence intervals: 2.90 (1.20 to 7.02)]. HIV seropositivity also predicted increased length of stay in those who were nonbacteremic [adjusted hazard ratios and 95% confidence intervals: 1.49 (1.11 to 2.01)].
  
  
  CONCLUSIONS
  Among febrile IDUs with SSTIs, a strong association between HIV seropositivity and health care resource utilization was found. Accordingly, attention to HIV serostatus should be considered in clinical disposition decisions for this vulnerable high-risk population.
authors.affiliation: Department of Emergency Medicine, The Johns Hopkins University, 5801 Smith Avenue, Suite 3220, Davis Building, Baltimore, MD 21209, USA. yhsieh1@jhmi.edu
authors.forename: Yu-Hsiang
authors.initials: YH
authors.lastname: Hsieh
authors.forename: Richard E
authors.initials: RE
authors.lastname: Rothman
authors.forename: John G
authors.initials: JG
authors.lastname: Bartlett
authors.forename: Samual
authors.initials: S
authors.lastname: Yang
authors.forename: Gabor D
authors.initials: GD
authors.lastname: Kelen
mesh_terms: D000328:Adult; D015142:Baltimore / Q000453:epidemiology; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D005260:Female; D006679:HIV Seropositivity / Q000150:complications*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D017192:Skin Diseases, Bacterial / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology; D018461:Soft Tissue Infections / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology; D015819:Substance Abuse, Intravenous / Q000150:complications*