Extremity infections in Intravenous Drug Abusers (IVDA) can be due localised reaction at the injection site or due to haematogenous spread. Emergency, surgical and orthopaedic clinicians have noticed an increase in the incidence of soft tissue abscess, osteomyelitis and septic arthritis presentations in past decade with a change in the microbiology on culture. Initial literature suggested Pseudomonas species as the most common organism with Staphylococcus aureus emerging as the most common organism three decades ago. Recent reports have identified oxacillin-resistant Staphylococcus aureus is becoming increasingly common. In the last decade, there was an outbreak of Anthrax in IVDA, with Scotland being at the epicenter. An understanding of infection process and change in microbiology is essential for proper management.
A literature search was performed on PubMed to list articles published in last 50 years. MeSH terms infection, abscess, osteomyelitis, drug abuse, intravenous were used. Clinical trials, retrospective studies, review articles and case reports were included to cover all the published work in English literature. Google scholar search was performed to look at current epidemiology and prevalence of IVDA in United Kingdom. The following discussion will address the current prevalence, common presentations, generic management, and change in microbiology of skin abscesses and osteomyelitis in greater detail and will emphasise the importance of these health risks for patients.