{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T06:27:58Z","timestamp":1787725678058,"version":"build-2784847793"},"reference-count":50,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T00:00:00Z","timestamp":1774051200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100013017","name":"Vanderbilt University Medical Center","doi-asserted-by":"publisher","award":["2 T32 HS026122-06"],"award-info":[{"award-number":["2 T32 HS026122-06"]}],"id":[{"id":"10.13039\/100013017","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Injection drug use-related infections cause substantial morbidity and can be mitigated by harm reduction programs. The objective was to describe Tennessee's injection-related infection hospitalization burden to guide syringe service program expansion efforts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>Injection-related infection hospitalizations were retrospectively evaluated from 2016 to 2023 using the Tennessee Hospital Discharge Data System. Injection-related infection criteria were met if discharge International Classification of Diseases, 10th Revision (ICD-10) codes indicated both drug use and an infection that could be introduced through injection. Hospitalization characteristics, including demographics (age, sex, race\/ethnicity, county), charges, and main payor, were described using counts (%) and median (interquartile range [IQR]). Incidence was calculated using US Census Bureau midyear estimates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During 2016\u20132023, injection-related infections comprised 1.6% (n = 79 276) of 5 million hospitalizations, incurring 602 321 hospitalization days and $5.38 billion in charges. The main payor was most frequently public insurance (n = 43 448, 54.8%) and self-pay (n = 23 001, 29.0%). Bacteremia or sepsis was most often diagnosed (n = 45 105, 56.9%), followed by skin and soft tissue (n = 17 152, 21.6%), endocarditis (n = 7386, 9.3%), musculoskeletal (n = 6458, 8.1%), and other (n = 3175, 4.0%) infections. Endocarditis incurred the greatest episodic length of stay (median 8 days [IQR 4\u201317]) and charges (median $60 633.50 [IQR $29 238\u2013$130 368]). The annual hospitalization rate peaked at 194.29 per 100 000 persons in 2018, plateaued, and then decreased to 186.38 per 100 000 persons in 2023. Eastern Tennessee, part of the Appalachia region, had the highest rates of injection-related infections.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Injection-related infection annual hospitalization rates since 2018 have plateaued. Expanded access to syringe service programs, particularly in eastern Tennessee, can help prevent these costly hospitalizations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ofid\/ofag161","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T12:41:50Z","timestamp":1773924110000},"source":"Crossref","is-referenced-by-count":0,"title":["Burden of Injection Drug Use-Related Infection Hospitalizations in Tennessee, 2016\u20132023"],"prefix":"10.1093","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4099-157X","authenticated-orcid":false,"given":"Emily R","family":"Moore","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Vanderbilt University Medical Center , Nashville, Tennessee ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anastasia N","family":"Cajigal","sequence":"additional","affiliation":[{"name":"HIV\/STI\/Viral Hepatitis Section, Tennessee Department of Health , Nashville, Tennessee ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amber J","family":"Coyne","sequence":"additional","affiliation":[{"name":"HIV\/STI\/Viral Hepatitis Section, Tennessee Department of Health , Nashville, Tennessee ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2610-6797","authenticated-orcid":false,"given":"Christine M","family":"Thomas","sequence":"additional","affiliation":[{"name":"HIV\/STI\/Viral Hepatitis Section, Tennessee Department of Health , Nashville, Tennessee ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,3,21]]},"reference":[{"key":"2026082601562961600_ofag161-B1","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1016\/S0140-6736(17)30003-X","article-title":"Syndemics and the biosocial conception of health","volume":"389","author":"Singer","year":"2017","journal-title":"The Lancet"},{"key":"2026082601562961600_ofag161-B2","doi-asserted-by":"crossref","first-page":"S213","DOI":"10.1093\/infdis\/jiaa432","article-title":"Infectious diseases and injection drug use: public health burden and response","volume":"222","author":"Levitt","year":"2020","journal-title":"J Infect Dis"},{"key":"2026082601562961600_ofag161-B3","doi-asserted-by":"crossref","first-page":"108518","DOI":"10.1016\/j.neuropharm.2021.108518","article-title":"Social vulnerabilities for substance use: stressors, socially toxic environments, and discrimination and racism","volume":"188","author":"Amaro","year":"2021","journal-title":"Neuropharmacology"},{"key":"2026082601562961600_ofag161-B4","doi-asserted-by":"crossref","first-page":"e37","DOI":"10.1093\/cid\/ciaa008","article-title":"Bacterial infections associated with substance use disorders, large cohort of United States hospitals, 2012\u20132017","volume":"71","author":"McCarthy","year":"2020","journal-title":"Clin Infect Dis"},{"key":"2026082601562961600_ofag161-B5","doi-asserted-by":"crossref","first-page":"e2012974","DOI":"10.1001\/jamanetworkopen.2020.12974","article-title":"Risk of new bloodstream infections and mortality among people who inject drugs with infective endocarditis","volume":"3","author":"Tan","year":"2020","journal-title":"JAMA Netw Open"},{"key":"2026082601562961600_ofag161-B6","doi-asserted-by":"crossref","first-page":"2102","DOI":"10.1097\/CCM.0000000000005141","article-title":"Epidemiology, outcomes, and trends of patients with sepsis and opioid-related hospitalizations in U.S. hospitals","volume":"49","author":"Alrawashdeh","year":"2021","journal-title":"Crit Care Med"},{"key":"2026082601562961600_ofag161-B7","doi-asserted-by":"crossref","first-page":"ofab009","DOI":"10.1093\/ofid\/ofab009","article-title":"High inpatient health care utilization and charges associated with injection drug use\u2013related infections: a cohort study, 2012\u20132015","volume":"8:","author":"Rapoport","year":"2021","journal-title":"Open Forum Infect Dis"},{"key":"2026082601562961600_ofag161-B8","doi-asserted-by":"crossref","first-page":"e357","DOI":"10.1016\/S2352-3018(17)30073-5","article-title":"HIV and the criminalization of drug use among people who inject drugs: a systematic review","volume":"4","author":"DeBeck","year":"2017","journal-title":"Lancet HIV"},{"key":"2026082601562961600_ofag161-B9","doi-asserted-by":"crossref","first-page":"ofab631","DOI":"10.1093\/ofid\/ofab631","article-title":"Six moments of infection prevention in injection drug use: an educational toolkit for clinicians","volume":"9","author":"Harvey","year":"2022","journal-title":"Open Forum Infect Dis"},{"key":"2026082601562961600_ofag161-B10","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1016\/j.idc.2020.06.007","article-title":"Soft tissue, bone, and joint infections in people who inject drugs","volume":"34","author":"Saldana","year":"2020","journal-title":"Infect Dis Clin North Am"},{"key":"2026082601562961600_ofag161-B11","first-page":"545","article-title":"Needle and syringe programmes and opioid substitution therapy for preventing HCV transmission among people who inject drugs: findings from a Cochrane review and meta-analysis. Addiction (Abingdon","volume":"113","author":"Platt","year":"2017","journal-title":"England"},{"key":"2026082601562961600_ofag161-B12","doi-asserted-by":"crossref","first-page":"e1002312","DOI":"10.1371\/journal.pmed.1002312","article-title":"Estimation of the cost-effectiveness of HIV prevention portfolios for people who inject drugs in the United States: a model-based analysis","volume":"14","author":"Bernard","year":"2017","journal-title":"PLoS Med"},{"key":"2026082601562961600_ofag161-B13","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1016\/j.idc.2020.06.013","article-title":"Harm reduction services to prevent and treat infectious diseases in people who use drugs","volume":"34","author":"Thakarar","year":"2020","journal-title":"Infect Dis Clin North Am"},{"key":"2026082601562961600_ofag161-B14","doi-asserted-by":"crossref","first-page":"ofaf197","DOI":"10.1093\/ofid\/ofaf197","article-title":"Injection-related infections and self-treatment practices among people who inject drugs in rural Appalachia","volume":"12","author":"Fanucchi","year":"2025","journal-title":"Open Forum Infect Dis"},{"key":"2026082601562961600_ofag161-B15"},{"key":"2026082601562961600_ofag161-B16","doi-asserted-by":"crossref","first-page":"S451","DOI":"10.1093\/infdis\/jiaa012","article-title":"Trends in morbidity, mortality, and cost of hospitalizations associated with infectious disease sequelae of the opioid epidemic","volume":"222","author":"Coyle","year":"2020","journal-title":"J Infect Dis"},{"key":"2026082601562961600_ofag161-B17","doi-asserted-by":"crossref","first-page":"e0242165","DOI":"10.1371\/journal.pone.0242165","article-title":"Population-based trends in hospitalizations due to injection drug use-related serious bacterial infections, Oregon, 2008 to 2018","volume":"15","author":"Capizzi","year":"2020","journal-title":"PLoS One"},{"key":"2026082601562961600_ofag161-B18","doi-asserted-by":"crossref","first-page":"S458","DOI":"10.1093\/infdis\/jiaa129","article-title":"Not just endocarditis: hospitalizations for selected invasive infections among persons with opioid and stimulant use diagnoses-North Carolina, 2010\u20132018","volume":"222","author":"Sredl","year":"2020","journal-title":"J Infect Dis"},{"key":"2026082601562961600_ofag161-B19","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1093\/cid\/ciaa823","article-title":"Hospital costs of injection drug use in Florida","volume":"72","author":"Coye","year":"2021","journal-title":"Clin Infect Dis"},{"key":"2026082601562961600_ofag161-B20","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1080\/08897077.2019.1635555","article-title":"The opioid and related drug epidemics in rural Appalachia: a systematic review of populations affected, risk factors, and infectious diseases","volume":"41","author":"Schalkoff","year":"2019","journal-title":"Subst Abus"},{"key":"2026082601562961600_ofag161-B21","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1097\/QAI.0000000000001098","article-title":"County-level vulnerability assessment for rapid dissemination of HIV or HCV infections among persons who inject drugs, United States","volume":"73","author":"Van Handel","year":"2016","journal-title":"J Acquir Immune Defic Syndr (1988)"},{"key":"2026082601562961600_ofag161-B22"},{"key":"2026082601562961600_ofag161-B23"},{"key":"2026082601562961600_ofag161-B24","doi-asserted-by":"crossref","first-page":"e1649","DOI":"10.1093\/cid\/ciaa1278","article-title":"Evaluating differences in opioid and stimulant use-associated infectious disease hospitalizations in Florida, 2016\u20132017","volume":"73","author":"Serota","year":"2020","journal-title":"Clin Infect Dis"},{"key":"2026082601562961600_ofag161-B25","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.drugpo.2018.02.001","article-title":"Identifying injection drug use and estimating population size of people who inject drugs using healthcare administrative datasets","volume":"55","author":"Janjua","year":"2018","journal-title":"Int J Drug Policy"},{"key":"2026082601562961600_ofag161-B26"},{"key":"2026082601562961600_ofag161-B27"},{"key":"2026082601562961600_ofag161-B28"},{"key":"2026082601562961600_ofag161-B29"},{"key":"2026082601562961600_ofag161-B30","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1016\/j.jacc.2016.05.049","article-title":"Predicting in-hospital mortality in patients with acute myocardial infarction","volume":"68","author":"McNamara","year":"2016","journal-title":"J Am Coll Cardiol"},{"key":"2026082601562961600_ofag161-B31","author":"Cox"},{"key":"2026082601562961600_ofag161-B32","doi-asserted-by":"crossref","first-page":"1391","DOI":"10.1161\/CIRCULATIONAHA.123.066921","article-title":"Trends in age, sex, and racial differences in the incidence of infective endocarditis in Florida and New York","volume":"149","author":"Anuforo","year":"2024","journal-title":"Circulation"},{"key":"2026082601562961600_ofag161-B33","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1016\/j.amepre.2024.12.020","article-title":"Widening racial disparities in the U.S. Overdose epidemic","volume":"68","author":"Smith","year":"2025","journal-title":"Am J Prev Med"},{"key":"2026082601562961600_ofag161-B34","doi-asserted-by":"crossref","first-page":"e213474","DOI":"10.1001\/jamanetworkopen.2021.3474","article-title":"Racial\/ethnic disparities in interhospital transfer for conditions with a mortality benefit to transfer among patients with medicare","volume":"4","author":"Shannon","year":"2021","journal-title":"JAMA Netw Open"},{"key":"2026082601562961600_ofag161-B35","doi-asserted-by":"crossref","first-page":"e76","DOI":"10.1097\/CCM.0000000000002776","article-title":"Racial and geographic disparities in interhospital ICU transfers","volume":"46","author":"Tyler","year":"2018","journal-title":"Crit Care Med"},{"key":"2026082601562961600_ofag161-B36","doi-asserted-by":"crossref","first-page":"e70","DOI":"10.1097\/MLR.0000000000000838","article-title":"Validation of an algorithm to identify infective endocarditis in people who inject drugs","volume":"56","author":"Ball","year":"2018","journal-title":"Med Care"},{"key":"2026082601562961600_ofag161-B37","doi-asserted-by":"crossref","first-page":"107906","DOI":"10.1016\/j.drugalcdep.2020.107906","article-title":"Validity of ICD-based algorithms to estimate the prevalence of injection drug use among infective endocarditis hospitalizations in the absence of a reference standard","volume":"209","author":"McGrew","year":"2020","journal-title":"Drug Alcohol Depend"},{"key":"2026082601562961600_ofag161-B38","doi-asserted-by":"crossref","first-page":"ofaa414","DOI":"10.1093\/ofid\/ofaa414","article-title":"Use of ICD-10 codes for identification of injection drug use\u2013associated infective endocarditis is nonspecific and obscures critical findings on impact of medications for opioid use disorder","volume":"7","author":"Marks","year":"2020","journal-title":"Open Forum Infect Dis"},{"key":"2026082601562961600_ofag161-B39","doi-asserted-by":"crossref","first-page":"S437","DOI":"10.1093\/infdis\/jiaa160","article-title":"Tracking substance use complications: a collaborative analysis of public health and academic medical center records on drug use-associated infective endocarditis","volume":"222","author":"de Gijsel","year":"2020","journal-title":"J Infect Dis"},{"key":"2026082601562961600_ofag161-B40","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1186\/1471-2334-13-171","article-title":"Use of electronic health record data to identify skin and soft tissue infections in primary care settings: a validation study","volume":"13","author":"Levine","year":"2013","journal-title":"BMC Infect Dis"},{"key":"2026082601562961600_ofag161-B41","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1093\/cid\/ciu750","article-title":"Comparison of trends in sepsis incidence and coding using administrative claims versus objective clinical data","volume":"60","author":"Rhee","year":"2015","journal-title":"Clin Infect Dis"},{"key":"2026082601562961600_ofag161-B42","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/j.idh.2016.10.001","article-title":"Administrative data has poor accuracy for surveillance of Staphylococcus aureus bacteraemia","volume":"21","author":"Das","year":"2016","journal-title":"Infect Dis Health"},{"key":"2026082601562961600_ofag161-B43","author":"Cajigal"},{"key":"2026082601562961600_ofag161-B44","doi-asserted-by":"crossref","first-page":"124","DOI":"10.15585\/mmwr.mm7306a2","article-title":"Routes of drug use among drug overdose deaths\u2014United States, 2020\u20132022","volume":"73","author":"Tanz","year":"2024","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2026082601562961600_ofag161-B45","author":"Saunders"},{"key":"2026082601562961600_ofag161-B46"},{"key":"2026082601562961600_ofag161-B47","author":"Armstrong"},{"key":"2026082601562961600_ofag161-B48","doi-asserted-by":"crossref","first-page":"e186371","DOI":"10.1001\/jamanetworkopen.2018.6371","article-title":"Prevalence of hepatitis C virus infection in US states and the District of Columbia, 2013 to 2016","volume":"1","author":"Rosenberg","year":"2018","journal-title":"JAMA Netw Open"},{"key":"2026082601562961600_ofag161-B49"},{"key":"2026082601562961600_ofag161-B50"}],"container-title":["Open Forum Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ofid\/advance-article-pdf\/doi\/10.1093\/ofid\/ofag161\/67459576\/ofag161.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/13\/4\/ofag161\/68099317\/ofag161.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/13\/4\/ofag161\/68099317\/ofag161.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T05:56:37Z","timestamp":1787723797000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ofid\/article\/doi\/10.1093\/ofid\/ofag161\/8533988"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,21]]},"references-count":50,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,3,30]]}},"URL":"https:\/\/doi.org\/10.1093\/ofid\/ofag161","relation":{},"ISSN":["2328-8957"],"issn-type":[{"value":"2328-8957","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,4]]},"published":{"date-parts":[[2026,3,21]]},"article-number":"ofag161"}}