SOFT-TISSUE ABSCESSES ASSOCIATED WITH PARENTERAL DRUG-ABUSE - PRESENTATION, MICROBIOLOGY, AND TREATMENT

Abscess formation at the site of drug injection is the commonest infec tious complication in drug addicts. This study characterizes the clini cal presentation of the condition, its current microbiology, and treat ment outcome. All patients presenting for treatment of soft tissue abs cesses associated with parenteral drug abuse over a 21-month period we re studied. Sixty-six patients with 70 subcutaneous abscesses after in jection of cocaine (85%), heroin (5%), or unreported drugs (10%) were identified. Only 42% were febrile (T > 37.5 degrees C), 54 percent had leukocytosis, and 47 percent had wound fluctuance. Wound cultures (24 3 isolates in 57 patients) grew predominately anaerobes (143 isolates) and facultative gram-positive cocci (88 isolates). Twenty-six blood c ultures were obtained, and five (19%) were positive, two with the same bacteria isolated from the wound. Of the patients tested, 29 percent were positive for hepatitis B surface antigen and 9 percent for HIV. S imple incision and drainage was effective in all cases. Classical sign s and symptoms of infection and abscess formation may be absent in thi s patient population. Many of these patients carry other blood-borne i nfections which the health professional must guard against. Cocaine in jection, and ''mixed'' aerobic-anaerobic infections predominated, in c ontrast to earlier reports, when narcotics and aerobes predominated. S imple incision and drainage is adequate treatment; antibiotics, when g iven, should cover gram-positive and anaerobic bacteria; gram-negative coverage is unnecessary.