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. 2025 Jul 17:10.1097/ADM.0000000000001545.
doi: 10.1097/ADM.0000000000001545. Online ahead of print.

Patients' Perspectives on Alternative Antibiotic Treatment Strategies for Infective Endocarditis Among Persons Who Inject Drugs

D Kane Cooper, Eunice A Okumu, Bailey McInnes, Maisun M Ansary, Maria Esposito, Carson Merenbloom, Bayla Ostrach, Vivian H Chu, Li-Tzy Wu, Carol Golin, David L Rosen, Asher J Schranz

Patients' Perspectives on Alternative Antibiotic Treatment Strategies for Infective Endocarditis Among Persons Who Inject Drugs

D Kane Cooper et al. J Addict Med. .

Abstract

Objectives: Injection drug use is a leading and growing risk factor for infective endocarditis (IE), as evidenced by a marked national increase in hospitalizations for drug use-associated infective endocarditis (DUA-IE). The typical treatment approach for persons with DUA-IE is a 6-week inpatient course of intravenous antimicrobials. This approach is resource-intensive, requiring substantial hospital resources and lengthy stays. Alternative methods of antibiotic delivery for DUA-IE treatment have been proposed and piloted, but their acceptance among people who inject drugs is unknown.

Methods: Persons hospitalized with DUA-IE (N = 16) completed semi-structured interviews to identify facilitators and barriers to 3 proposed IE treatment options: (A) hospitalization for the entirety of antibiotic treatment, the current standard of care; (B) home-based outpatient parenteral antimicrobial therapy via indwelling catheter; or (C) weekly outpatient visits for long-acting antibiotic infusion. Interviews were transcribed and thematically coded to identify participant perspectives and preferences among these strategies.

Results: Option A was ranked the most preferred treatment regimen (8 participants, 50%), followed by options C (5 participants, 31%) and B (3 participants, 19%). Participants felt option A provided the most effective treatment for their endocarditis, despite dissatisfaction with the hospitalization length. Options B and C appealed to participants given the convenience of outpatient care; however, inadequate transportation and housing instability were prominently cited as barriers.

Conclusions: These diverse patient perspectives should inform trials to evaluate the effectiveness of alternative antibiotic delivery strategies, as well as interventions to improve patient-centered decision-making for DUA-IE treatment.

Keywords: antibiotics; endocarditis; substance-related disorders.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

Figure 1.
Figure 1.
Predominant themes and representative quotations of participants regarding the facilitators and barriers to each treatment option.
See this image and copyright information in PMC

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