Determinants of Cutaneous Injection-related Infections among Injection Drug Users at an Emergency Department.

INTRODUCTION Cutaneous injection-related infections (CIRI) are a primary reason injection drug users (IDU) access the emergency department (ED). METHODOLOGY Using Cox proportional hazard regression, we examined predictors of ED use for CIRI, stratified by sex, among 1083 supervised injection facility (SIF) users. RESULTS Over a four-year period, 289 (27%) visited the ED for CIRI, yielding an incidence density for females of 23.8 (95% confidence interval (CI): 19.3 - 29.0) and males of 19.2 per 100 person-years (95% CI: 16.7 - 22.1). Factors associated with ED use for CIRI among females included residing in the Downtown Eastside (DTES) (adjusted hazard ratio [AHR] = 2.06 [1.13 - 3.78]) and being referred to hospital by SIF nurses (AHR = 4.48 [2.76 - 7.30]). Among males, requiring assistance with injection (AHR = 1.38 [1.01 - 1.90]), being HIV-positive (AHR = 1.85 [1.34 - 2.55]), and being referred to hospital by SIF nurses (AHR = 2.97 [1.93 - 4.57]) were associated with an increased likelihood of an ED visit for CIRI. CONCLUSION These results suggest SIF nurses have facilitated referral of hospital treatment for CIRI, highlighting the need for continued development of efficient and collaborative efforts to reduce the burden of CIRI.