Injection site microflora in persons with diabetes: why needle reuse is not associated with increased infections?

Research output: Contribution to journalJournal articlepeer-review

Standard

Injection site microflora in persons with diabetes : why needle reuse is not associated with increased infections? / Wareham-Mathiassen, Sofia; Bay, Lene; Glenting, Vera Pinto; Fatima, Naireen; Bengtsson, Henrik; Bjarnsholt, Thomas.

In: APMIS, Vol. 130, No. 7, 2022, p. 404-416.

Research output: Contribution to journalJournal articlepeer-review

Harvard

Wareham-Mathiassen, S, Bay, L, Glenting, VP, Fatima, N, Bengtsson, H & Bjarnsholt, T 2022, 'Injection site microflora in persons with diabetes: why needle reuse is not associated with increased infections?', APMIS, vol. 130, no. 7, pp. 404-416. https://doi.org/10.1111/apm.13230

APA

Wareham-Mathiassen, S., Bay, L., Glenting, V. P., Fatima, N., Bengtsson, H., & Bjarnsholt, T. (2022). Injection site microflora in persons with diabetes: why needle reuse is not associated with increased infections? APMIS, 130(7), 404-416. https://doi.org/10.1111/apm.13230

Vancouver

Wareham-Mathiassen S, Bay L, Glenting VP, Fatima N, Bengtsson H, Bjarnsholt T. Injection site microflora in persons with diabetes: why needle reuse is not associated with increased infections? APMIS. 2022;130(7):404-416. https://doi.org/10.1111/apm.13230

Author

Wareham-Mathiassen, Sofia ; Bay, Lene ; Glenting, Vera Pinto ; Fatima, Naireen ; Bengtsson, Henrik ; Bjarnsholt, Thomas. / Injection site microflora in persons with diabetes : why needle reuse is not associated with increased infections?. In: APMIS. 2022 ; Vol. 130, No. 7. pp. 404-416.

Bibtex

@article{bab4756f4ab94dccb3b382bb0b25dc51,
title = "Injection site microflora in persons with diabetes: why needle reuse is not associated with increased infections?",
abstract = "Needle reuse is a common practice and primary cause of customer compliance issues such as pain, bruising, clogging, injection site reactions (ISR), and associated lipodystrophy. This study aimed to characterize skin microflora at injection sites and establish microbial contamination of used pen injectors and needles. The second objective was to evaluate the risk of infections during typical and repeated subcutaneous injections. 50 participants with diabetes and 50 controls (n = 100) were sampled through tape strips and skin swabs on the abdomen and thigh for skin microflora. Used pen injectors and needles were collected after in-home use and from the hospital after drug administration by health care professionals (HCPs). Samples were analyzed by conventional culture, matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF), mass spectrometry (MS), confocal laser scanning microscopy (CLSM), and 16S/ITS high throughput sequencing (HTS). A mathematical model simulated the risk of needle contamination during injections. Injection site populations were in 102 cells/cm2 order, with increased viable bacteria and anaerobic bacteria on the skin in persons with diabetes (p = 0.05). Interpersonal variation dominated other factors such as sex or location. A higher prevalence of Staphylococcus aureus on abdominal skin was found in persons with diabetes than control skin (p ≤ 0.05). Most needles and cartridges (95% and 86%) contained no biological signal. The location of the device collection (hospital vs home-use) and use regimen did not affect contamination. CLSM revealed scarcely populated skin microflora scattered in aggregates, diplo, or single cells. Our mathematical model demonstrated that penetrating bacteria colonies during subcutaneous injection is unlikely. These findings clarify the lack of documented skin infections from subcutaneous insulin injections in research. Furthermore, these results can motivate the innovation and development of durable, reusable injection systems with pharmacoeconomic value and a simplified and enhanced user experience for patients.",
keywords = "Injection sites, insulin delivery, medical devices, needle reuse, skin microflora",
author = "Sofia Wareham-Mathiassen and Lene Bay and Glenting, {Vera Pinto} and Naireen Fatima and Henrik Bengtsson and Thomas Bjarnsholt",
note = "Publisher Copyright: {\textcopyright} 2022 The Authors. APMIS published by John Wiley & Sons Ltd on behalf of Scandinavian Societies for Medical Microbiology and Pathology.",
year = "2022",
doi = "10.1111/apm.13230",
language = "English",
volume = "130",
pages = "404--416",
journal = "A P M I S. Acta Pathologica, Microbiologica et Immunologica Scandinavica",
issn = "0903-4641",
publisher = "Wiley Online",
number = "7",

}

RIS

TY - JOUR

T1 - Injection site microflora in persons with diabetes

T2 - why needle reuse is not associated with increased infections?

AU - Wareham-Mathiassen, Sofia

AU - Bay, Lene

AU - Glenting, Vera Pinto

AU - Fatima, Naireen

AU - Bengtsson, Henrik

AU - Bjarnsholt, Thomas

N1 - Publisher Copyright: © 2022 The Authors. APMIS published by John Wiley & Sons Ltd on behalf of Scandinavian Societies for Medical Microbiology and Pathology.

PY - 2022

Y1 - 2022

N2 - Needle reuse is a common practice and primary cause of customer compliance issues such as pain, bruising, clogging, injection site reactions (ISR), and associated lipodystrophy. This study aimed to characterize skin microflora at injection sites and establish microbial contamination of used pen injectors and needles. The second objective was to evaluate the risk of infections during typical and repeated subcutaneous injections. 50 participants with diabetes and 50 controls (n = 100) were sampled through tape strips and skin swabs on the abdomen and thigh for skin microflora. Used pen injectors and needles were collected after in-home use and from the hospital after drug administration by health care professionals (HCPs). Samples were analyzed by conventional culture, matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF), mass spectrometry (MS), confocal laser scanning microscopy (CLSM), and 16S/ITS high throughput sequencing (HTS). A mathematical model simulated the risk of needle contamination during injections. Injection site populations were in 102 cells/cm2 order, with increased viable bacteria and anaerobic bacteria on the skin in persons with diabetes (p = 0.05). Interpersonal variation dominated other factors such as sex or location. A higher prevalence of Staphylococcus aureus on abdominal skin was found in persons with diabetes than control skin (p ≤ 0.05). Most needles and cartridges (95% and 86%) contained no biological signal. The location of the device collection (hospital vs home-use) and use regimen did not affect contamination. CLSM revealed scarcely populated skin microflora scattered in aggregates, diplo, or single cells. Our mathematical model demonstrated that penetrating bacteria colonies during subcutaneous injection is unlikely. These findings clarify the lack of documented skin infections from subcutaneous insulin injections in research. Furthermore, these results can motivate the innovation and development of durable, reusable injection systems with pharmacoeconomic value and a simplified and enhanced user experience for patients.

AB - Needle reuse is a common practice and primary cause of customer compliance issues such as pain, bruising, clogging, injection site reactions (ISR), and associated lipodystrophy. This study aimed to characterize skin microflora at injection sites and establish microbial contamination of used pen injectors and needles. The second objective was to evaluate the risk of infections during typical and repeated subcutaneous injections. 50 participants with diabetes and 50 controls (n = 100) were sampled through tape strips and skin swabs on the abdomen and thigh for skin microflora. Used pen injectors and needles were collected after in-home use and from the hospital after drug administration by health care professionals (HCPs). Samples were analyzed by conventional culture, matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF), mass spectrometry (MS), confocal laser scanning microscopy (CLSM), and 16S/ITS high throughput sequencing (HTS). A mathematical model simulated the risk of needle contamination during injections. Injection site populations were in 102 cells/cm2 order, with increased viable bacteria and anaerobic bacteria on the skin in persons with diabetes (p = 0.05). Interpersonal variation dominated other factors such as sex or location. A higher prevalence of Staphylococcus aureus on abdominal skin was found in persons with diabetes than control skin (p ≤ 0.05). Most needles and cartridges (95% and 86%) contained no biological signal. The location of the device collection (hospital vs home-use) and use regimen did not affect contamination. CLSM revealed scarcely populated skin microflora scattered in aggregates, diplo, or single cells. Our mathematical model demonstrated that penetrating bacteria colonies during subcutaneous injection is unlikely. These findings clarify the lack of documented skin infections from subcutaneous insulin injections in research. Furthermore, these results can motivate the innovation and development of durable, reusable injection systems with pharmacoeconomic value and a simplified and enhanced user experience for patients.

KW - Injection sites

KW - insulin delivery

KW - medical devices

KW - needle reuse

KW - skin microflora

U2 - 10.1111/apm.13230

DO - 10.1111/apm.13230

M3 - Journal article

C2 - 35460122

AN - SCOPUS:85132608331

VL - 130

SP - 404

EP - 416

JO - A P M I S. Acta Pathologica, Microbiologica et Immunologica Scandinavica

JF - A P M I S. Acta Pathologica, Microbiologica et Immunologica Scandinavica

SN - 0903-4641

IS - 7

ER -

ID: 313377673