Josh Bamberger’s Abscess Identification and Treatment
This manuscript is intended to be a primer on the care and treatment of skin and soft tissue infection (SSTI) among injection drug users. It is intended for primary care providers, nurses and lay practitioners who care for people who inject drugs in community settings. While incision and drainage is a simple procedure, we recommend that all SSTI be treated by a licensed provider in a controlled environment. However, if a licensed provider is not available, we hope that this manuscript will assist all people working with drug users to treat people living with SSTI in a manner that reduces suffering to the greatest extent possible.
It is a common belief among drug users and health professionals that injecting a nonsterile, contaminated substance is the cause of most SSTI. When comparing insulin dependent diabetics, who inject sterile insulin two to three times a day to people who inject illicit drugs, there is a much higher incidence of SSTI among drug users. However, bacteria that are cultured from the wounds of IDU almost always are bacteria found living harmlessly on the skin of most people.
The relationship between the injected material and the development of an SSTI is complicated and poorly understood. Some drugs such as amphetamines (speed, ice, etc.) or cocaine are lipophobic and therefore are not easily absorbed intramuscularly (IM) or subcutaneously (SQ). These substances when injected IM or SQ will immediately induce a burning sensation and initiate an inflammatory response. This inflammatory response can be a precursor for developing an SSTI as the user’s immune system will wall off the site of a missed IV injection creating a favorable environment for bacterial proliferation and SSTI development. Therefore, users who inject amphetamines or cocaine who miss IV injections or inject SQ or IM are at high risk for developing an SSTI.