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. 2020 Dec 17;71(10):e650-e656.
doi: 10.1093/cid/ciaa365.

Evaluation of Partial Oral Antibiotic Treatment for Persons Who Inject Drugs and Are Hospitalized With Invasive Infections

Laura R Marks  1 , Stephen Y Liang  1   2 , Dharushana Muthulingam  1 , Evan S Schwarz  2   3 , David B Liss  2   3 , Satish Munigala  1 , David K Warren  1 , Michael J Durkin  1
Affiliations

Evaluation of Partial Oral Antibiotic Treatment for Persons Who Inject Drugs and Are Hospitalized With Invasive Infections

Laura R Marks et al. Clin Infect Dis. .

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.

Keywords: endocarditis; opioid use disorder; osteomyelitis; substance abuse.

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Figures

Figure 1.
Figure 1.
Kaplan-Meier survival curve of PWID admitted with invasive bacterial infections stratified by type of antimicrobial therapy. Abbreviations: abx, antibiotics; IV, intravenous; PWID, persons who inject drugs.
See this image and copyright information in PMC

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