The Journal of Bone and Joint Surgery, Vol 76, Issue 10 1526-1530, Copyright © 1994 by Journal of Bone and Joint Surgery, Inc
Abscesses secondary to parenteral abuse of drugs. A study of demographic and bacteriological characteristics
SB Schnall, PD Holtom and JC Lilley
Department of Orthopaedics, University of Southern California Medical Center, Los Angeles.
Seventy-seven patients (eighty-six lesions) who had been seen over a
fifteen-month period because of an abscess at the site of injection due to
parenteral abuse of drugs were identified in a retrospective review.
Forty-one patients (forty-five abscesses) had had cultures before
antibiotic therapy. Thirty (73 per cent) of the forty-one patients had
isolation of a streptococcal species on culture, with microaerophilic
streptococci identified in sixteen. Twenty (49 per cent) of the forty-one
patients had isolation of a staphylococcal species. Four of the
staphylococcal organisms were identified as oxacillin-resistant
Staphylococcus aureus. Two patients who had three abscesses each had
different organisms in each abscess. Gram-negative bacilli were identified
in the cultures of ten (24 per cent) of the forty-one patients; patients
who were forty years old or more had a sixfold greater risk of having
gram-negative bacilli. Specimens of the abscess had been obtained from
thirty-six patients for culture from twelve to seventy-two hours after the
first dose of antibiotics had been given. The microbiological findings in
these cultures were similar to those in the cultures of specimens obtained
from patients before antibiotics had been given. Five (14 per cent) of
thirty-five patients who had been tested for the human immunodeficiency
virus had a positive result. This finding emphasizes the importance of
surveillance for and precautions against the human immunodeficiency virus
in people who abuse drugs parenterally.
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