Tissue-retained needles in people who inject drugs: A systematic review of case reports and series on clinical presentations, complications and management.

Abstract

Tissue-retained needles from intravenous drug use can cause rare but severe complications, ranging from local to systemic infections to needle embolization. Due to the limited evidence and the lack of epidemiological studies on the issue, we systematically reviewed the literature focusing on case reports and case series on the clinical presentations, diagnostic approaches, and management of tissue-retained needle fragments. A systematic review of English-language case reports and case series was conducted (PROSPERO ID: CRD42024517020) on 15 November 2024, using PubMed and Scopus. Two authors performed the search independently and in duplicate following the PRISMA flow diagram. Case reports were included when the retained needles among people who inject drugs were confirmed by imaging, surgery or autopsy. Data on clinical characteristics, presentation, complications and outcomes were extracted by two reviewers and summarized descriptively. From 1479 citations, we included 46 publications reporting 52 cases [47 (90%) patients and 5 (9.6%) autopsy cases]. Patients were mostly young adults with a median age of 35.0 (range: 22-55) years and predominantly male [n = 37/52 (71%)]. No deaths were reported among the patients presenting with needle fragments; in the autopsy cases, the needles were incidental findings and not the cause of death. Although injection sites were not systematically imaged in all cases, nearly one third [n = 15/52 (29%)] of cases involved multiple retained needles. Needles migrated via circulation were most often found in the heart [n = 23/52 (44%)] or the lungs [n = 13/52 (25%)]. One fifth [10/47 (21%)] of the patients received antibiotics without needle retrieval, and in 18/47 patients (38%) the needle was surgically removed. Retained needle fragments among people who inject drugs are found in a range of anatomical sites, are often multiple, are not associated with fatal outcomes and are often incidental findings in autopsies. Management varies substantially as some patients receive antibiotics alone while some have needles removed surgically.