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

Sofia Wareham-Mathiassen, Lene Bay, Vera Pinto Glenting, Naireen Fatima, Henrik Bengtsson, Thomas Bjarnsholt*

*Corresponding author af dette arbejde

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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.

OriginalsprogEngelsk
TidsskriftAPMIS
Vol/bind130
Udgave nummer7
Sider (fra-til)404-416
Antal sider13
ISSN0903-4641
DOI
StatusUdgivet - 2022

Bibliografisk note

Funding Information:
This work was supported by a research grant from the Danish Diabetes Academy, which is funded by the Novo Nordisk Foundation, grant number NNF17S0031406 and the Innovation Fund grant number 9065‐00120B. In addition, the authors would like to thoroughly thank all volunteers, Dr. Dorte Lindqvist Hansen and the Steno Diabetes Center Copenhagen, Steno Diabetes Center Nord Jylland, Christian Andreasen for statistics, Lasse Kvich and Ida Clement Thaarup for general training in the laboratory/microscope, Dinesh Krishnamoorthy for assistance with Python and, finally, the LEO foundation for funding Lene Bay.

Funding Information:
This work was supported by a research grant from the Danish Diabetes Academy, which is funded by the Novo Nordisk Foundation, grant number NNF17S0031406 and the Innovation Fund grant number 9065-00120B. In addition, the authors would like to thoroughly thank all volunteers, Dr. Dorte Lindqvist Hansen and the Steno Diabetes Center Copenhagen, Steno Diabetes Center Nord Jylland, Christian Andreasen for statistics, Lasse Kvich and Ida Clement Thaarup for general training in the laboratory/microscope, Dinesh Krishnamoorthy for assistance with Python and, finally, the LEO foundation for funding Lene Bay.

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

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