Title : Intravenous drug users and spondylodiscitis as an associated infection: A serious public health problem at the global level, including in Albania
Abstract:
Introduction: Intravenous drug use (IVDU) is a growing global health concern associated with severe infections and comorbidities. Among these, spondylodiscitis has been increasingly reported across Europe and is now observed in Albania.Data from the Institute of Public Health (IHP, 2022) show that 4.2% of adolescents aged 15–18 experimented with ecstasy,1.2% with heroin and 3.2% with cocaine, highlighting a vulnerable subgroup and underscoring the clinical and socio-economic burden of IVDU-related infections.
Objective: To evaluate the association between intravenous drug use (IVDU) and spondylodiscitis, emphasizing epidemiological trends, microbial etiology, and clinical outcomes, with a particular focus on Albania within the broader European context.
Methods: A systematic review of the English-language literature (Medline, Cochrane Library; was conducted using the search terms “intravenous drug use,” “spondylodiscitis,” “spinal infection,” and “Albania.” National epidemiological data from the Albanian Institute of Public Health (IHP, 2022) were integrated to contextualize local trends.
Results and Discussion: International literature shows that IVDU patients often present with bacteremia, abscesses, endocarditis, and musculoskeletal infections such as spondylodiscitis. The condition typically arises through hematogenous spread from peripheral foci, facilitated by the vascularity of intervertebral discs. Common pathogens include Staphylococcus aureus, gram-negative bacteria, Cutibacterium acnes, Staphylococcus epidermidis and fungi. In Europe incidence has increased significantly with Germany reporting a 104% rise between 2005 and 2021.IVDU patients are generally younger with fewer comorbidities but show higher recurrence rates and poor adherence to long-term antibiotic therapy, complicating management and increasing socio-economic burden.
Conclusion: Intravenous drug use is closely associated with spondylodiscitis, a condition with rising incidence globally and in Albania. The microbial spectrum is diverse, and management is hindered by social instability and poor treatment compliance. Effective strategies require early diagnosis, tailored therapeutic approaches and close interdisciplinary collaboration among infectious disease specialists, neurosurgeons and public health authorities to mitigate the clinical and psychosocial impact of this dual challenge.
Keywords: intravenous drug use, spondylodiscitis, Albania, spinal infection, public health, risk factors.
