Background: Patients with substance use disorders admitted for severe bacterial infection are in a prime position to be screened for important co-infections. However, data suggest that standard screening for co-infections in this population during hospital admission can vary in frequency and type of testing. Methods: We performed a retrospective review of patients to evaluate screening for co-infections during admission, followed by a case–control analysis to determine factors associated with lack of any screening. Results: We identified 280 patients with 320 eligible admissions. Most were male and Caucasian with unstable housing. Only 67 (23.9%) patients had a primary-care provider. About 89% ( n = 250) of our cohort were screened for one or more co-infection during their first admission with one patient never screened despite subsequent admissions. Of those screened, the greatest proportion was HIV (219, 81.4% of those without history of HIV), HCV (94, 79.7% of those without a prior positive HCV antibody), syphilis (206, 73.6%), gonorrhea, and chlamydia (47, 16.8%) with new positive tests identified in 60 (21.4%) people. Screening for all five co-infections was only completed in 15 (14.0%) of the 107 patients who had screening indications. Overall, a high proportion of those screened had a new positive test, including three cases of neurosyphilis, highlighting the importance of screening and treatment initiation. One patient was prescribed HIV pre-exposure prophylaxis at discharge and only 37 (34.6%) of those eligible were referred for HCV treatment or follow-up. In multivariable case–control analysis, non-Medicaid insurance (OR 2.8, 95% CI: 1.2–6.6, p = 0.02), use of only 1 substance (OR 2.9, 95% CI: 1.3–6.5, p < 0.01), and no documented screening recommendations by the infectious disease team (OR 3.7, 95% CI: 1.5–8.8, p < 0.01), were statistically significantly associated with lack of screening for any co-infection during hospital admission. Conclusion: Our data suggest additional interventions are needed to improve inpatient screening for co-infections in this population.

Background: Patients with substance use disorders (SUDs) and severe bacterial infections requiring prolonged antibiotic therapy represent a significant challenge to providers due to complexity of care coordination required to ensure safe and effective treatment. Our institution developed a patient-centered multidisciplinary discharge planning conference, OPTIONS-DC, to address this challenge. Methods: We conducted a retrospective review to evaluates parameters between patients who received an OPTIONS-DC and those who did not. Results: We identified 73 patients receiving an OPTIONS-DC and 100 who did not. More patients with an OPTIONS-DC were < 40 years of age (76.7% versus 61.0%, OR = 2.3, 95% CI = 1.1–4.7, p = 0.02), had positive HCV antibody testing (58.9% versus 41.0%, OR = 2.1, 95% CI = 1.1–3.8, p = 0.02), injection drug use (93.2% versus 79.0%, OR = 3.6 95% CI = 1.3–10.1, p = 0.01), used methamphetamines (84.9% versus 72.0%, OR = 2.2, 95% CI = 1.0–4.8, p = 0.04), and started inpatient SUD treatment (80.8% versus 63%, OR = 2.5, 95% CI = 1.2–5.0, p = 0.04) compared with those without a conference. The OPTIONS-DC group was more likely to be diagnosed with bacteremia (74.0% versus 57.0%, OR = 2.1, 95% CI = 1.1–4.1, p = 0.02), endocarditis (39.7% versus21.0%, OR = 2.5, 95% CI = 1.3–4.9, p = 0.03), vertebral osteomyelitis (45.2% versus 15.0%, OR = 4.7, 95% CI = 2.3–9.6, p < 0.01), and epidural abscess (35.6% versus 10.0%, OR = 5.0, 95% CI = 2.2–11.2, p < 0.01) and require 4 weeks or more of antibiotic treatment (97.3% versus 51.1%, OR = 34.1, 95% CI = 7.9–146.7, p = 0.01). Patients with an OPTIONS-DC were also more likely to be admitted between 2019 and 2020 than between 2018 and 2019 (OR = 4.1, 95% CI = 2.1–7.9, p < 0.01). Conclusion: Patients with an OPTIONS-DC tended to have more complicated infections and longer courses of antibiotic treatment. While further research on outcomes is needed, patients receiving an OPTIONS-DC were able to successfully complete antibiotic courses across a variety of settings.

Background Patients with substance used disorder (SUD) are at high risk of hepatitis c virus (HCV) infection. During admission for acute illness, patients with SUD are often screened for or known to have untreated chronic HCV with outpatient follow-up recommended. However, many barriers to HCV treatment exists including lack of insurance, no primary care provider (PCP), drug cost, and transportation. Therefore, we aimed to investigate HCV follow-up and treatment in patients with SUD post-hospitalization. Methods We performed a retrospective review of patients with SUD admitted for a severe bacterial infection between July 2015 and March 2020. A descriptive analysis was performed to evaluate patients with positive HCV testing instructed to follow-up outpatient for HCV treatment per discharge summary. We collected key information via chart review including location and attendance of follow-up as well as HCV testing and treatment status within two years of discharge. Results We identified 108 patients during the study period with chronic HCV in which 48 were recommended follow-up for outpatient HCV treatment (Table 1). 38 (79.2%) were recommended to follow-up with PCP and 10 (20.8%) with hepatology. 15 patients (31.2%) made their follow-up appointment. 30 patients (62.5%) had documented repeat HCV testing within two years of discharge. Of these, one (3.3%) was HCV antibody (Ab) only, 10 (33.3%) were HCV Ab plus viral load (VL), and 19 (63.3%) were HCV VL alone. 41 patients (85.4%) had no evidence of HCV treatment and 7 (14.6%) had documented clearance (4 confirmed treatment, 2 presumed treatment, and one documented treatment without confirmed testing). Of the 7 treated, 4 (57.1%) had a PCP prior to admission, whereas in the 41 untreated, 5 (12.2%) had a PCP. Table 1:HCV Follow-Up Outcomes Conclusion A low proportion of patients were confirmed to initiate and complete outpatient HCV therapy following hospital discharge. Many patients were lost to follow-up and had no repeat testing available. One-third of patients with repeat testing had repeat HCV Ab screen indicating an area for diagnostic stewardship. More pro-active approaches coordinating HCV therapy in patients with SUD requiring hospitalization for other infections are warranted in order to prevent unnecessary sequelae including HCV cirrhosis and carcinoma. Disclosures Monica K. Sikka, MD, F2G: Site research investigator.