CDC Report Shows MRSA Risk Associated With Injection Drug Use

Individuals who inject drugs are at an increased risk of developing invasive methicillin-resistant Staphylococcus aureus (MRSA). Alarmingly, opioid overdose death rates have increased by over 200% during 1999-2015.¹ Heroin overdose death rates increased by about 300% during 2011-2015.¹ Studies have consistently demonstrated the increased risk of HIV and hepatitis C infections. Now the CDC study sheds light on the importance of public health education and interventions to prevent MRSA infections.¹ Pharmacists can play an important role in educating the public on the dangers of drug abuse including the risk of developing MRSA infections.

Study Methods, Results

Surveillance data from the CDC’s Emerging Infections Program were evaluated during 2005-2016 to assess the effects of the opioid epidemic on invasive MRSA infections.¹ Individuals who inject drugs were approximately 16.3 times more likely to develop invasive MRSA infections than others.¹ The 6 states examined were California (3 counties); Connecticut (statewide); Georgia (8 counties); Minnesota, New York, and Tennessee (1 county each).¹ The study found that invasive MRSA from injecting drugs increased from 4.1% in 2011 to 9.2% in 2016.¹ Nonsterile drug use was the most common cause of invasive MRSA infection. Study limitations include the possibility of misclassifying information regarding drug use in the medical records, and the rates are based on 2011 data since this is the only year population estimates are available for individuals who inject drugs.

MRSA Signs, Symptoms and Treatment

MRSA can cause many complications including sepsis, pneumonia, bloodstream infections, and death. Pharmacists can play an important role in educating patients on signs and symptoms of an infection on the skin that may appear as the following: red, swollen, painful, warm to the touch, full of pus or other drainage, and fever. If these MRSA symptoms appear, then patients should cover the area with a bandage, wash their hands, and contact their physician.² Additionally, personal items such as towels, washcloths, razors, and clothing should not be shared with family members or friends, and all items should be washed thoroughly. Unfortunately, MRSA is resistant to many antibiotics. Antibiotic treatment options include Bactrim, vancomycin, ceftaroline, clindamycin, minocycline, doxycycline, and daptomycin.

Prevention Strategies

Prevention strategies are key for reducing the risk of invasive MRSA infection. Community-wide education on the dangers of drug abuse and injection drug use is crucial to reducing the risk of infection. Pharmacists can recommend medication-assisted treatment programs for patients. Studies have shown that syringe services programs (SSPs) can reduce the risk of infections.³ Not all states allow the sale of needles without a prescription, as it remains a controversial issue of whether this will increase drug use. Actually, evidence demonstrates that SSPs do not increase drug use or crime.³ Many SSPs offer other prevention items and strategies such as alcohol swabs, vials of sterile water, condoms, education on safer injection practices, wound care, vaccines, and overdose prevention.

References:

• Jackson KA, Bohm MK, Brooks JT, et al. Invasive Methicillin-Resistant Staphylococcus aureus Infections Among Persons Who Inject Drugs-Six Sites, 2005-2016. MMWR Morb Mortal Wkly Rep. 2018;67:625-628. DOI:http://dx.doi.org/10.15585/mmwr.mm6722a2.
• Centers for Disease Control and Prevention. Methicillin-resistant Staphylococcus aureus (MRSA). https://www.cdc.gov/mrsa/. Accessed June 9, 2018.
• Centers for Disease Control and Prevention. Syringe services programs. https://www.cdc.gov/hiv/risk/ssps.html. Accessed June 9, 2018.