Evaluation of Partial Oral Antibiotic Treatment for Persons Who Inject Drugs and Are Hospitalized With Invasive Infections. (2nd April 2020)

• Record Type: Journal Article
• Authors: Marks, Laura R; Liang, Stephen Y; Muthulingam, Dharushana; Schwarz, Evan S; Liss, David B; Munigala, Satish; Warren, David K; Durkin, Michael J
• Is Part Of: Clinical infectious diseases. Volume 71:Number 10(2020)
• Page Start: e650
• Page End: e656
• Publication Date: 2020-04-02
• Subjects: substance abuse -- opioid use disorder -- endocarditis -- osteomyelitis; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciaa365
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract: Background: Persons who inject drugs (PWID) are at risk of invasive infections; however, hospitalizations to treat these infections are frequently complicated by against medical advice (AMA) discharges. This study compared outcomes among PWID who (1) completed a full course of inpatient intravenous (IV) antibiotics, (2) received a partial course of IV antibiotics but were not prescribed any antibiotics on AMA discharge, and (3) received a partial course of IV antibiotics and were prescribed oral antibiotics on AMA discharge. Methods: A retrospective, cohort study of PWID aged ≥18 years admitted to a tertiary referral center between 01/2016 and 07/2019, who received an infectious diseases consultation for an invasive bacterial or fungal infection. Results: 293 PWID were included in the study. 90-day all-cause readmission rates were highest among PWID who did not receive oral antibiotic therapy on AMA discharge (n = 46, 68.7%), compared with inpatient IV (n = 43, 31.5%) and partial oral (n = 27, 32.5%) antibiotics. In a multivariate analysis, 90-day readmission risk was higher among PWID who did not receive oral antibiotic therapy on AMA discharge (adjusted hazard ratio [aHR], 2.32; 95% confidence interval [CI], 1.41–3.82) and not different among PWID prescribed oral antibiotic therapy on AMA discharge (aHR, .99; 95% CI, .62–1.62). Surgical source control (aHR, .57; 95% CI, .37–.87) and addiction medicine consultation (aHR, .57; 95% CI, .38–.86) were both associated with reduced readmissions. Conclusions: Our single-center study suggests access to oral antibiotic therapy for PWID who cannot complete prolonged inpatient IV antibiotic courses is beneficial. Abstract : We observed a reduction in 90-day readmission rates in PWID with invasive infections who left AMA who were prescribed oral antibiotic therapy, compared with those who were not. Readmission rates among those who received outpatient oral antibiotics were similar to those who completed inpatient IV antibiotic therapy.