Affiliation:
1. Division of Infectious Diseases, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
2. Division of Emergency Medicine, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
3. Section of Medical Toxicology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
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.
Funder
National Institutes of Health
National Institute on Drug Abuse
Barnes Jewish Hospital Foundation
Publisher
Oxford University Press (OUP)
Subject
Infectious Diseases,Microbiology (medical)
Reference30 articles.
1. Invasive methicillin-resistant Staphylococcus aureus infections among persons who inject drugs—six sites, 2005–2016;Jackson;MMWR Morb Mortal Wkly Rep,2018
2. High morbidity and mortality among patients with sentinel admission for injection drug use-related infective endocarditis;Leahey;Open Forum Infect Dis,2019
3. Candida bloodstream infections among persons who inject drugs—Denver metropolitan area, Colorado, 2017–2018;Barter;MMWR Morb Mortal Wkly Rep,2019
4. Changes in infective endocarditis admissions in Pennsylvania during the opioid epidemic;Meisner;Clin Infect Dis,2020
5. Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications: a scientific statement for healthcare professionals from the American Heart Association;Baddour;Circulation,2015
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