SSTIs in injecting drug users can be caused by a large variety of pathogens, including S. aureus and Group A Streptococcus/S. pyogenes, which are common in all types of SSTI, but also by anaerobes, environmental organisms and gram negative enterobacteriaceae, especially if the injection site is in the groin area.

• Pillar 1: Cover for gram positive organisms (mainly beta-haemolytic streptococci and S. aureus)
• Pillar 2: Cover for gram negative organisms
• Pillar 3: Cover for anaerobic organisms

Use the table below for the antimicrobial treatment overview of severe SSTI in people who inject drugs.

• FigureSevere SSTI in people who inject drugs - treatment overview

N.B. Treat patients presenting with septic shock following the guidance for necrotising fasciitis.

Depends on severity and need for surgical source control.

Uncomplicated infection without bacteraemia or undrained abscess: 7 days.

Rarely, people who inject drugs (PWID) acquire wound botulism. See sampling section for sampling advice in suspected wound botulism.

If necrotising fasciitis is suspected, an urgent surgical review should be requested, as debridement is life-saving.

Advice from Microbiology or Infectious Diseases on antimicrobial therapy should be sought as soon as possible.