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Infections are common in IV drug users (IVDU). Heroin was by far the most common drug abused in ourseries of 80 patients. The spectrum of infections in our patients with ages ranging from 20-63, varied frommild skin infections to life threatening and fatal conditions such as septic shock, necrotizing fasciitis, spinalcord infarction and endocarditis with cerebral septic emboli. Our studies showed that bacterial infections inIV drug users originate from three different sources: 1. Skin (contaminated hands) 2. Oral microbiota 3.Environmental sources including water, soil and plants. The most common skin bacteria isolated weremethicillin susceptible and methicillin resistant Staphylococcus aureus (MSSA and MRSA). In our studyStreptococcus anginosus group was the most common oral bacteria in IVDU with Streptococcusintermedius predominating, followed by group A Streptococcus, Prevotella spp., Eikenella corrodens,Haemophilus parainfluenzae and group C Streptococcus. A variety of environmental bacteria were isolated,but the total number of patients in this group was smaller. Bacteria originating from water, soil or plantspresent were: Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Delftia acidovorans,Commamonas sp., Chryseobacterium spp., Klebsiella spp., Serratia marcesens, Burkholderia cepacia,Pseudomonas fluorescence and Acinetobacter. Twenty four out of 48 (50%) Staphylococcus aureusinfectedpatients were bacteremic, followed by 6/10 (60%) group A Streptococcus infected cases. Life threateninginfections were more common with those infected with Staphylococcus aureus or Pseudomonas aeruginosa.Few had Candida sp., likely of oral origin. Hepatitis C was less common (2/37) 5.4% in the group with oralbacteria and more frequent in MSSA/MRSA patients (13/47) 27.7%. There was 1 coinfection with humanimmunodeficiency virus each in oral and skin bacteria associated groups. The bacteria isolated provided aclue to the source of infections and habits of the IV drug users.

Infections in Injection Drug Users: The Significance of Oral Bacteria and a Comparison with Bacteria Originating from Skin and Environmental Sources