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Fabricant SA, Abramson EL, Hutchings K, Vien A, Scherer M, Kapadia SN. PICC Your Poison: Resident Beliefs and Attitudes Regarding Discharge Parenteral Antibiotics for Patients Who Inject Drugs. Open Forum Infect Dis 2024; 11:ofae364. [PMID: 38994443 PMCID: PMC11237634 DOI: 10.1093/ofid/ofae364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 06/26/2024] [Indexed: 07/13/2024] Open
Abstract
Background Serious injection-related infections (SIRIs) in people who inject drugs often lead to prolonged hospitalizations or premature discharges. This may be in part due to provider reluctance to place peripherally inserted central catheters (PICCs) for outpatient parenteral antibiotic therapy in this population. Because internal medicine (IM) residents are often frontline providers in academic centers, understanding their perspectives on SIRI care is important to improve outcomes. Methods We surveyed IM residents in a large urban multicenter hospital system about SIRI care with a novel case-based survey that elicited preferences, comfort, experience, and stigma. The survey was developed using expert review, cognitive interviewing, and pilot testing. Results are reported with descriptive statistics and linear regression. Results Of 116 respondents (response rate 34%), most (73%) were uncomfortable discharging a patient with active substance use home with a PICC, but comfortable (87%) with discharge to postacute facilities. Many (∼40%) endorsed high levels of concern for PICC misuse or secondary line infections, but larger numbers cited concerns about home environment (50%) or loss to follow-up (68%). While overall rates were low, higher stigma was associated with more concerns around PICC use (r = -0.3, P = .002). A majority (58%) believed hospital policies against PICC use in SIRI may act as a barrier to discharge, and 74% felt initiation of medications for opioid use disorder (MOUD) would increase their comfort discharging with a PICC. Conclusions Most IM residents endorsed high levels of concern about PICC use for SIRI, related to patient outcomes and perceived institutional barriers, but identified MOUD as a mitigating factor.
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Affiliation(s)
- Scott A Fabricant
- Department of Medicine, New York-Presbyterian, New York, New York, USA
| | - Erika L Abramson
- Department of Pediatrics, Weill Cornell Medicine, New York, New York, USA
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Kayla Hutchings
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Alexis Vien
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Matthew Scherer
- Division of Infectious Diseases, Columbia University Medical Center, New York, New York, USA
| | - Shashi N Kapadia
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
- Division of Infectious Diseases, Weill Cornell Medicine, New York, New York, USA
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2
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Kuye IO, Prichett LM, Stewart RW, Berkowitz SA, Buresh ME. The association between opioid use disorder and skilled nursing facility acceptances: A multicenter retrospective cohort study. J Hosp Med 2024; 19:377-385. [PMID: 38458154 DOI: 10.1002/jhm.13302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 01/21/2024] [Accepted: 01/31/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Prior single-hospital studies have documented barriers to acceptance that hospitalized patients with opioid use disorder (OUD) face when referred to skilled nursing facilities (SNFs). OBJECTIVE To examine the impact of OUD on the number of SNF referrals and the proportion of referrals accepted. DESIGN, SETTINGS, AND PARTICIPANTS A retrospective cohort study of hospitalizations with SNF referrals in 2019 at two academic hospitals in Baltimore, MD. EXPOSURE OUD status was determined by receipt of medications for OUD during admission, upon discharge, or the presence of a diagnosis code for OUD. KEY RESULTS The cohort included 6043 hospitalizations (5440 hospitalizations of patients without OUD and 603 hospitalizations of patients with OUD). Hospitalizations of patients with OUD had more SNF referrals sent (8.9 vs. 5.6, p < .001), had a lower proportion of SNF referrals accepted (31.3% vs. 46.9%, p < .001), and were less likely to be discharged to an SNF (65.6% vs. 70.3%, p = .003). The effect of OUD status on the number of SNF referrals and the proportion of referrals accepted remained significant in multivariable analyses. Our subanalysis showed that reduced acceptances were driven by the hospitalizations of patients discharged without medications for OUD and those receiving methadone. Hospitalizations of patients discharged on buprenorphine were accepted at the same rates as hospitalizations of patients without OUD. CONCLUSIONS This multicenter retrospective cohort study found that hospitalizations of patients with OUD had more SNF referrals sent and fewer referrals accepted. Further work is needed to address the limited discharge options for patients with OUD.
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Affiliation(s)
- Ifedayo O Kuye
- Division of Hospital Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Laura M Prichett
- Biostatistics, Epidemiology and Data Management Core, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rosalyn W Stewart
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Addiction Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Scott A Berkowitz
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Megan E Buresh
- Division of Addiction Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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3
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Yang WT, Dombrowski JC, Glick SN, Kim HN, Beieler AM, Lan KF, Dhanireddy S. Partial-Oral Antibiotic Therapy for Bone and Joint Infections in People With Recent Injection Drug Use. Open Forum Infect Dis 2023; 10:ofad005. [PMID: 36726538 PMCID: PMC9887258 DOI: 10.1093/ofid/ofad005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/05/2023] [Indexed: 01/09/2023] Open
Abstract
Background Limited outcome data exist regarding partial-oral antibiotic therapy, defined as oral antibiotics as part of a patient's treatment, for bone and joint infections (BJIs) in people who inject drugs (PWID). Methods We conducted a retrospective study of all PWID reporting drug use within 3 months and BJIs requiring ≥6 weeks of antibiotics in an urban safety-net hospital between February 1, 2019, and February 1, 2021. Treatment outcomes were assessed by chart review. Rates of failure, defined as death, symptoms, or signs concerning for worsening or recurrent infections, were assessed 90 and 180 days after completion of antibiotics. Univariate logistic regression was used to explore the association between covariates and failure. Results Of 705 patients with BJI, 88 (13%) were PWID. Eighty-six patients were included in the final cohort. Forty-four (51%) were homeless, 50 (58%) had spine infection, 68 (79%) had surgery, and 32 of 68 (47%) had postoperatively retained hardware. Twelve (14%) of 86 patients received exclusively intravenous (IV) antibiotics, and 74 (86%) received partial-oral antibiotics. Twelve (14%) of 86 patients had patient-directed discharge. In those who received partial-oral antibiotics, the failure rate was 20% at 90 days and 21% at 180 days after completion of intended treatment. Discharge to a medical respite and follow-up with infectious diseases (ID) or surgery were negatively associated with odds of failure. Conclusions Partial-oral treatment of BJI in PWID was a common practice and often successful when paired with medical respite and follow-up with ID or surgery.
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Affiliation(s)
- Wei-Teng Yang
- Correspondence: Wei-Teng Yang, MD, MPH, Section of Addiction Medicine, Division of General Internal Medicine and Geriatrics, Department of Medicine, Oregon Health & Science University, 3181 Southwest Samuel Jackson Park Road, Mail Code UNH30, Portland, OR 97239. E-mail:
| | - Julia C Dombrowski
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA,HIV/STD Program, Public Health-Seattle & King County, Seattle, Washington, USA
| | - Sara N Glick
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA,HIV/STD Program, Public Health-Seattle & King County, Seattle, Washington, USA
| | - H Nina Kim
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| | | | - Kristine F Lan
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
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Narayanan S, Ching PR, Traver EC, George N, Amoroso A, Kottilil S. Predictors of Nonadherence Among Patients With Infectious Complications of Substance Use Who Are Discharged on Parenteral Antimicrobial Therapy. Open Forum Infect Dis 2022; 10:ofac633. [PMID: 36686627 PMCID: PMC9845962 DOI: 10.1093/ofid/ofac633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 11/23/2022] [Indexed: 12/14/2022] Open
Abstract
Background The management of invasive infections related to substance use disorder (SUD) needing parenteral antimicrobial therapy is challenging and may have poor treatment outcomes including nonadherence and lack of completion of parenteral antimicrobial therapy. Methods In this retrospective cohort of 201 patients with invasive infections related to SUD, we looked at frequency and determinants of unfavorable outcomes including nonadherence. Results Seventy-nine percent of patients with SUD-related infection completed parenteral antibiotic therapy in skilled nursing facilities. A total of 21.5% of patient episodes had documentation of nonadherence. Nonadherence was higher in patients with active injection drug use (IDU) (28.5% versus 15% in non IDU; adjusted odds ratio [OR] 2.36; 95% confidence interval [CI], 1.1-5.5; P = .024), patients with active SUD in the prior year (24.5% vs 11%, P = .047), patients with use of more than 1 illicit substance (30.3% vs 17%, P = .031), as well as in people experiencing homelessness (32.8% vs 15.7% in stably housed, P = .005). In a multivariate model, nonadherence was significantly associated with IDU (OR, 2.38; 95% CI, 1.03-5.5) and homelessness (OR, 2.25; 95% CI, 1.01-4.8) Medication for opioid use disorder was prescribed at discharge in 68% of overall cohort and was not associated with improved outcomes for any of the above groups. Conclusions Nonadherence to parenteral antimicrobial therapy is high in the most vulnerable patients with unstable high-risk SUD and adverse social determinants of health.
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Affiliation(s)
- Shivakumar Narayanan
- Correspondence: Shivakumar Narayanan, MD, Institute of Human Virology, University of Maryland School of Medicine, 725 W Lombard St, S211B, Baltimore, MD 21201 ()
| | - Patrick R Ching
- Division of Infectious Diseases, Department of Medicine, Washington UniversitySchool of Medicine, St. Louis, Missouri, USA
| | - Edward C Traver
- University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Nivya George
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Anthony Amoroso
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Tassey TE, Ott GE, Alvanzo AAH, Peirce JM, Antoine D, Buresh ME. OUD MEETS: A novel program to increase initiation of medications for opioid use disorder and improve outcomes for hospitalized patients being discharged to skilled nursing facilities. J Subst Abuse Treat 2022; 143:108895. [PMID: 36215913 DOI: 10.1016/j.jsat.2022.108895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 08/09/2022] [Accepted: 09/20/2022] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Rates of hospitalizations from medical complications of opioid use disorder (OUD) are rising and many of these patients require post-acute care at skilled nursing facilities (SNFs). However, access to medication for OUD (MOUD) at SNFs remains low and patients with OUD have high rates of patient-directed discharge (PDD) and hospital readmissions. METHODS Opioid Use Disorder Medical Patient Engagement, Enrollment in treatment and Transitional Supports (OUD MEETS) program was a clinical pilot designed to increase initiation of buprenorphine and methadone for hospitalized patients with OUD requiring post-acute care. The program comprises a hospital partnership with two SNFs and two opioid treatment programs (OTPs) to improve recovery supports and access to MOUD for patients discharged to SNF. RESULTS Between August 2019 and August 2020, study staff approached 49 hospitalized patients with OUD for participation in OUD MEETS. Twenty-eight of 30 eligible patients enrolled in the program and initiated buprenorphine or methadone. Twenty-seven (96 %) enrolled patients successfully completed hospital treatment. Twenty-three (85 %) patients successfully completed medical treatment at SNF. Thirteen (46 %) enrolled patients had confirmed linkage to OUD treatment post-SNF. One patient left the hospital (4 %) and four patients left SNF (15 %) via PDD. CONCLUSION OUD MEETS demonstrates feasibility of hospital, SNF, and OTP partnership to integrate MOUD treatment into SNFs, with high rates of completion of medical treatment and low rates of PDD. Future research should find sustainable ways to improve access to MOUD at post-acute care facilities, including through regulatory and policy changes.
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Affiliation(s)
- Theresa E Tassey
- Behavioral Health Systems Baltimore, Baltimore, MD, United States of America
| | - Geoffrey E Ott
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Anika A H Alvanzo
- Division of Addiction Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States of America; Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States of America
| | - Jessica M Peirce
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States of America
| | - Denis Antoine
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States of America
| | - Megan E Buresh
- Division of Addiction Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States of America; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
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Baddour LM, Weimer MB, Wurcel AG, McElhinney DB, Marks LR, Fanucchi LC, Esquer Garrigos Z, Pettersson GB, DeSimone DC. Management of Infective Endocarditis in People Who Inject Drugs: A Scientific Statement From the American Heart Association. Circulation 2022; 146:e187-e201. [PMID: 36043414 DOI: 10.1161/cir.0000000000001090] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND The American Heart Association has sponsored both guidelines and scientific statements that address the diagnosis, management, and prevention of infective endocarditis. As a result of the unprecedented and increasing incidence of infective endocarditis cases among people who inject drugs, the American Heart Association sponsored this original scientific statement. It provides a more in-depth focus on the management of infective endocarditis among this unique population than what has been provided in prior American Heart Association infective endocarditis-related documents. METHODS A writing group was named and consisted of recognized experts in the fields of infectious diseases, cardiology, addiction medicine, and cardiovascular surgery in October 2021. A literature search was conducted in Embase on November 19, 2021, and multiple terms were used, with 1345 English-language articles identified after removal of duplicates. CONCLUSIONS Management of infective endocarditis in people who inject drugs is complex and requires a unique approach in all aspects of care. Clinicians must appreciate that it requires involvement of a variety of specialists and that consultation by addiction-trained clinicians is as important as that of more traditional members of the endocarditis team to improve infective endocarditis outcomes. Preventive measures are critical in people who inject drugs and are cured of an initial bout of infective endocarditis because they remain at extremely high risk for subsequent bouts of infective endocarditis, regardless of whether injection drug use is continued.
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7
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Marks LR, Nolan NS, Liang SY, Durkin MJ, Weimer MB. Infectious Complications of Injection Drug Use. Med Clin North Am 2022; 106:187-200. [PMID: 34823730 DOI: 10.1016/j.mcna.2021.08.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The opioid overdose epidemic is one of the leading causes of death in adults. Its devastating effects have included not only a burgeoning overdose crisis but also multiple converging infectious diseases epidemics. The use of both opioids and other substances through intravenous (IV) administration places individuals at increased risks of infectious diseases ranging from invasive bacterial and fungal infections to human immunodeficiency virus (HIV) and viral hepatitis. In 2012, there were 530,000 opioid use disorder (OUD)-related hospitalizations in the United States (US), with $700 million in costs associated with OUD-related infections. The scale of the crisis has continued to increase since that time, with hospitalizations for injection drug use-related infective endocarditis (IDU-IE) increasing by as much as 12-fold from 2010 to 2015. Deaths from IDU-IE alone are estimated to result in over 7,260,000 years of potential life lost over the next 10 years. There have been high-profile injection-related HIV outbreaks, and injection drug use (IDU) is now the most common risk factor for hepatitis C virus (HCV). As this epidemic continues to grow, clinicians in all aspects of medical care are increasingly confronted with infectious complications of IDU. This review will describe the pathogenesis, clinical syndromes, epidemiology, and models of treatment for common infectious complications among persons who inject drugs (PWIDs).
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Affiliation(s)
- Laura R Marks
- Division of Infectious Diseases, Washington University in St. Louis School of Medicine, Campus Box 8051, 4523 Clayton Avenue, St. Louis, MO 63110-1093, USA.
| | - Nathanial S Nolan
- Division of Infectious Diseases, Washington University in St. Louis School of Medicine, Campus Box 8051, 4523 Clayton Avenue, St. Louis, MO 63110-1093, USA
| | - Stephen Y Liang
- Division of Infectious Diseases, Washington University in St. Louis School of Medicine, Campus Box 8051, 4523 Clayton Avenue, St. Louis, MO 63110-1093, USA; Division of Emergency Medicine, Washington University in St. Louis School of Medicine
| | - Michael J Durkin
- Division of Infectious Diseases, Washington University in St. Louis School of Medicine, Campus Box 8051, 4523 Clayton Avenue, St. Louis, MO 63110-1093, USA
| | - Melissa B Weimer
- Program in Addiction Medicine, Department of Medicine, Yale School of Medicine, E.S. Harkness Memorial Building A, 367 Cedar Street, Suite 417A, New Haven, CT 06510, USA
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8
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Fanucchi LC, Murphy SM, Surratt H, Kapadia SN, Walsh SL, Grubbs JA, Thornton AC, Nuzzo P, Lofwall MR. Design and protocol of the Buprenorphine plus Outpatient Parenteral Antimicrobial Therapy (B-OPAT) study: a randomized clinical trial of integrated outpatient treatment of opioid use disorder and severe, injection-related infections. Ther Adv Infect Dis 2022; 9:20499361221108005. [PMID: 35847566 PMCID: PMC9277431 DOI: 10.1177/20499361221108005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 06/01/2022] [Indexed: 02/06/2023] Open
Abstract
Introduction A marked increase in hospitalizations for severe, injection-related infections (SIRI) has been associated with the opioid epidemic. Outpatient parenteral antibiotic therapy (OPAT) is typically not offered to persons with opioid use disorder (OUD) and SIRI, though increasing evidence suggests it may be feasible and safe. This study evaluates the efficacy and cost-effectiveness of an integrated care model combining Buprenorphine treatment of OUD with OPAT for SIRI (B-OPAT) compared with treatment as usual on key OUD, infectious disease, and health economic outcomes. B-OPAT expands and incorporates key elements of established clinical models, including inpatient initiation of buprenorphine for OUD, inpatient infectious disease consultation for SIRI, office-based treatment of OUD, and OPAT, and includes more frequent clinical outpatient visits than standard OPAT. A qualitative evaluation is included to contextualize effectiveness outcomes and identify barriers and facilitators to intervention adoption and implementation. Methods B-OPAT is a single-site, randomized, parallel-group, superiority trial recruiting 90 adult inpatients hospitalized with OUD and SIRI who require at least 2 weeks of intravenous (IV) antibiotic therapy. After screening, eligible participants are randomized 1:1 to either discharge once medically stable to an integrated outpatient treatment care model combining Buprenorphine and OPAT (B-OPAT) or to Treatment As Usual (TAU). The primary outcome measure is the proportion of urine samples negative for illicit opioids in the 12 weeks after discharge from the hospital. Key secondary OUD outcomes include self-reported number of days of illicit opioid abstinence and 12-week retention in buprenorphine treatment. The infection outcomes are completion of recommended IV antibiotic therapy, peripherally inserted central catheter (PICC) complications, and readmission related to primary SIRI. Conclusions The B-OPAT study will help address the important question of whether it is clinically effective and cost-effective to discharge persons with OUD and SIRI to an integrated outpatient care model combining OUD treatment with OPAT relative to TAU (Clinicaltrials.gov Identifier: NCT04677114).
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Affiliation(s)
- Laura C. Fanucchi
- Division of Infectious Diseases, College of
Medicine, University of Kentucky, 845 Angliana Ave., Lexington, KY, 40508,
USA
- Center on Drug and Alcohol Research, College of
Medicine, University of Kentucky, Lexington, KY, USA
| | - Sean M. Murphy
- Department of Population Health Sciences, Weill
Cornell Medicine, New York, NY, USA
| | - Hilary Surratt
- Center on Drug and Alcohol Research, College of
Medicine, University of Kentucky, Lexington, KY, USA
- Department of Behavioral Science, College of
Medicine, University of Kentucky, Lexington, KY, USA
| | - Shashi N. Kapadia
- Department of Population Health Sciences, Weill
Cornell Medicine, New York, NY, USA
- Division of Infectious Diseases, Weill Cornell
Medicine, New York, NY, USA
| | - Sharon L. Walsh
- Center on Drug and Alcohol Research, College of
Medicine, University of Kentucky, Lexington, KY, USA
- Departments of Behavioral Science and
Psychiatry, College of Medicine, University of Kentucky, Lexington, KY,
USA
- Department of Pharmaceutical Sciences, College
of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - James A. Grubbs
- Division of Infectious Diseases, College of
Medicine, University of Kentucky, Lexington, KY, USA
| | - Alice C. Thornton
- Division of Infectious Diseases, College of
Medicine, University of Kentucky, Lexington, KY, USA
| | - Paul Nuzzo
- Center on Drug and Alcohol Research, College
of Medicine, University of Kentucky, Lexington, KY, USA
| | - Michelle R. Lofwall
- Center on Drug and Alcohol Research, College
of Medicine, University of Kentucky, Lexington, KY, USA
- Departments of Behavioral Science and
Psychiatry, College of Medicine, University of Kentucky, Lexington, KY,
USA
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Beieler AM, Klein JW, Bhatraju E, Iles-Shih M, Enzian L, Dhanireddy S. Evaluation of Bundled Interventions for Patients With Opioid Use Disorder Experiencing Homelessness Receiving Extended Antibiotics for Severe Infection. Open Forum Infect Dis 2021; 8:ofab285. [PMID: 34189180 PMCID: PMC8231362 DOI: 10.1093/ofid/ofab285] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 05/26/2021] [Indexed: 11/14/2022] Open
Abstract
Hospitalizations for serious infections in patients with opioid use disorder (OUD) experiencing homelessness are common. Patients receiving 4 interventions (infectious disease consultation, addiction consultation, case management, and medications for OUD [MOUD]) had higher odds of clinical cure (unadjusted odds ratio [OR], 3.15; P = .03; adjusted OR, 3.03; P = .049) and successful retention in addiction care at 30 days (unadjusted OR, 5.46; P = .01; adjusted OR, 6.36; P = .003).
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Affiliation(s)
- Alison M Beieler
- Harborview Medical Center, Seattle, Washington, USA
- Correspondence: Alison M Beieler, PA-C, MPAS, Infectious Disease, Harborview Medical Center, 325 Ninth Ave, Box #359930, Seattle, WA 98104 ()
| | - Jared W Klein
- Harborview Medical Center, Seattle, Washington, USA
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Elenore Bhatraju
- Harborview Medical Center, Seattle, Washington, USA
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Matthew Iles-Shih
- Harborview Medical Center, Seattle, Washington, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Leslie Enzian
- Harborview Medical Center, Seattle, Washington, USA
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
- Edward Thomas House Medical Respite, Seattle, Washington, USA
| | - Shireesha Dhanireddy
- Harborview Medical Center, Seattle, Washington, USA
- Division of Allergy and Infectious Disease, Department of Medicine, University of Washington, Seattle, Washington, USA
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