Prevalence of Injection-Related Bacterial and Fungal Infection Among People Who Inject Drugs: A Systematic Review and Meta-analysis.

Background: Despite the increasing burden of injection-related bacterial and fungal infections, there has been no recent synthesis of their epidemiology. We performed a systematic review and meta-analysis evaluating the prevalence and incidence of injection-related infections among people who inject drugs. Methods: We searched EMBASE, MEDLINE, Web of Science, and PsycINFO for articles published since 1 January 2010. Eligible studies assessed the prevalence or incidence of ≥1 injection-related infection among people who recently injected drugs. Random-effects meta-analysis was used to calculate pooled estimates of infection prevalence, according to infection type and prevalence period. Results: Of 8097 articles identified, 87 were eligible for inclusion (prevalence, 78; incidence, 9). Data were available for 25 countries, including 10 low- or middle-income countries. The prevalence of skin and soft-tissue infections (including skin abscess and cellulitis) was 13% in the past month (95% confidence interval [CI], 9%-19% [11 studies]), 30% in the past 3-12 months (23%-37% [23 studies]), and 47% across the lifetime (29%-66% [7 studies]). The prevalence of endocarditis was 2% in the past month (95% CI, 1%-3% [4 studies]), 2% in the past 3-12 months (2%-3% [5 studies]), and 6% across the lifetime (3%-10% [8 studies]). Prevalence of sepsis and/or bloodstream infection was 1% in the past month (95% CI, 1%-2% [2 studies]), 7% in the past 3-12 months (4%-13% [3 studies]), and 8% across the lifetime (3%-19% [5 studies]). Conclusions: Injection-related infections are a common complication of injecting drug use. Interventions to reduce their occurrence and associated disease burden are needed.