We retrospectively evaluated off-label use of dalbavancin as secondary therapy in 32 patients with serious Staphylococcus aureus infections (endocarditis, osteomyelitis, septic thrombophlebitis, epidural infection) who were also persons who use drugs. The majority of patients (56%) had a clinical response to treatment. Only 1 patient who completed the intended dalbavancin course experienced a treatment failure.

BACKGROUND Outpatient parenteral antimicrobial therapy (OPAT) is a safe way to administer intravenous (IV) antimicrobial therapy to patients with the potential to decrease hospital length of stay (LOS). Often, homeless patients with complex infections, who could otherwise be treated as an outpatient, remain in the hospital for the duration of IV antibiotic treatment. Injection drug use (IDU) is a barrier to OPAT. OBJECTIVE To evaluate our experience with administering OPAT to homeless patients at a medical respite facility and determine if patients could complete a successful course of antibiotics. DESIGN Using retrospective chart review, demographics, diagnosis, and comorbidities including mental illness, current IDU, and remote IDU (>3 months ago) were recorded. Surgical, microbiologic, and antimicrobial therapy including route (IV or oral), duration of therapy, and adverse events were abstracted. PARTICIPANTS Homeless patients >18 years old who received OPAT at medical respite after discharge, no exclusions. MAIN MEASUREMENTS Primary outcome was successful completion of OPAT at medical respite. Secondary outcome was successful antimicrobial course completion for a specific diagnosis. RESULTS Forty‐six (87%) patients successfully completed a defined course of antibiotic therapy. Thirty‐four (64%) patients were successfully treated with OPAT at medical respite. Readmission rate was 30%. The average length of OPAT was 22 days. The cost savings to our institution (using $1500/day inpatient cost) was $25,000 per episode of OPAT. CONCLUSIONS OPAT can be successful in a supervised medical respite setting for homeless patients with the help of a multidisciplinary team, and can decrease inpatient LOS resulting in cost savings. Journal of Hospital Medicine 2016;11:531–535. © 2016 Society of Hospital Medicine

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 OR 3.15, p= 0.03; adjusted OR 3.03, p=0.049) and successful retention in addiction care at 30 days (unadjusted OR 5.46, p=0.01; adjusted OR 6.36, p=0.003).

Outpatient parenteral antimicrobial therapy (OPAT) programs can provide high‐value care but may be challenging in people who inject drugs (PWID) and homeless individuals. We conducted a single‐center, retrospective, cohort study of adults who received OPAT at an urban, public health hospital from January 1, 2015 to April 30, 2016, grouped by PWID and housing status. Outcomes included clinical cure, length of stay, secondary bacteremia, line‐tampering, and readmission. A total of 596 patients (homeless PWID (9%), housed PWID (8%), homeless non‐PWID (8%), and housed non‐PWID (75%), received OPAT. Assuming that patients lost to follow‐up failed therapy, homeless PWID were least likely to achieve cure compared with housed non‐PWID, (odds ratio [OR] = 0.33, 95% CI 0.18‐0.59; P < .001). Housed PWID were also less likely to achieve cure (OR = 0.37, 95% CI 0.20‐0.67; P = .001). Cure rates did not differ in patients not lost to follow‐up. OPAT can be effective in PWID and the homeless, but loss to follow‐up is a significant barrier.