title: High rates of abscesses and chronic wounds in community-recruited injection drug users and associated risk factors.
abstract: OBJECTIVE
  Abscesses and chronic wounds are common among injection drug users (IDUs) though chronic wounds have been understudied. We assessed the risk factors associated with both acute and chronic wounds within a community-based population of IDUs frequenting the Baltimore City Needle Exchange Program (BNEP).
  
  
  METHODS
  We performed a cross-sectional study of BNEP clients aged 18 years or more who completed an in-person survey regarding active or prior wounds including abscesses (duration <8 weeks) and chronic wounds (duration ≥8 weeks), injection practices, and skin care. Factors associated with wounds were analyzed using univariate and multivariate logistic regressions.
  
  
  RESULTS
  Of the 152 participants, 63.2% were men, 49.3% were white, 44.7% were African American, 34.9% had any type of current wound, 17.8% had an active abscess, and 19.7% had a current chronic wound. Abscesses were more common in women (odds ratio [OR], 2.56; 95% confidence interval [CI], 1.10-5.97) and those reporting skin-popping (OR, 5.38; 95% CI, 1.85-15.67). In a multivariate model, risk factors for an abscess included injecting with a family member/partner (adjusted OR [AOR], 4.06; 95% CI, 0.99-16.58). In a multivariable analysis of current chronic wounds, cleaning skin with alcohol before injection was protective (AOR, 0.061; 95% CI, 0.0064-0.58).
  
  
  CONCLUSIONS
  Abscesses and chronic wounds were prevalent among a sample of IDUs in Baltimore. Abscesses were associated with injection practices, and chronic wounds seemed linked to varying skin and tool cleaning practices. There is a pressing need for wound-related education and treatment efforts among IDUs who are at greatest risk for skin-related morbidity.
authors.affiliation: From the Department of Medicine (MES, KEJ), Division of Infectious Diseases, Johns Hopkins Medical Institutions, Baltimore, MD; and Baltimore City Health Department (NR, PC), Baltimore, MD.
authors.forename: Maria Elisa
authors.initials: ME
authors.lastname: Smith
authors.forename: Natanya
authors.initials: N
authors.lastname: Robinowitz
authors.forename: Patrick
authors.initials: P
authors.lastname: Chaulk
authors.forename: Kristine E
authors.initials: KE
authors.lastname: Johnson
mesh_terms: D000038:Abscess / Q000453:epidemiology*; D000328:Adult; D015142:Baltimore / Q000453:epidemiology; D003430:Cross-Sectional Studies; D055030:Drug Users / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D065840:Protective Factors; D012307:Risk Factors; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D014947:Wounds and Injuries / Q000453:epidemiology*