A Novel Program to Provide Drug Recovery Assistance and Outpatient Parenteral Antibiotic Therapy in People Who Inject Drugs

Gelman, Stephanie S.; Stenehjem, Eddie; Foster, Rachel; Tinker, Nick; Grisel, Nancy; Webb, Brandon

doi:10.1093/ofid/ofab629

Cited by 5 publications

(2 citation statements)

References 19 publications

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“…Management of serious bacterial infections in people who inject drugs (PWID) is complicated by concerns with utilizing OPAT. Gelman and colleagues describe a novel approach to managing drug recovery assistance and outpatient parenteral antibiotic therapy (DRA-OPAT) for PWID [ 34 ]. They established a multidisciplinary Comprehensive Care of Drug Addiction and Infection (CCDAI) team including an ID physician, hospitalist, psychiatrist, case manager, ID pharmacist, home health care nurse, and a representative from the partner detoxification facility.…”

Section: Resultsmentioning

confidence: 99%

A Baker’s Dozen of Top Antimicrobial Stewardship Intervention Publications in Non–Hospital Care Settings in 2021

Green

Marx

Chahine

et al. 2022

Open Forum Infectious Diseases

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The scope of antimicrobial stewardship programs has expanded beyond the acute hospital setting. The need to optimize antimicrobial use in emergency departments, urgent, primary, and specialty care clinics, nursing homes, and long-term care facilities prompted the development of core elements of stewardship programs in these settings. Identifying the most innovative and well-designed stewardship literature in these novel stewardship areas can be challenging. The Southeastern Research Group Endeavor (SERGE-45) network evaluated antimicrobial stewardship-related, peer-reviewed literature published in 2021 that detailed actionable interventions specific to the non-hospital setting. The top 13 publications were summarized following identification using a modified Delphi technique. This article highlights the selected interventions and may serve as a key resource for expansion of antimicrobial stewardship programs beyond the acute hospital setting.

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Section: Resultsmentioning

confidence: 99%

A Baker’s Dozen of Top Antimicrobial Stewardship Intervention Publications in Non–Hospital Care Settings in 2021

Green

Marx

Chahine

et al. 2022

Open Forum Infectious Diseases

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“… 20 , 21 One program reported significantly lower antibiotic completement rates for PWID with infective endocarditis treated at a SUD treatment facility (46%) compared to a historical control group treated in the hospital (74%), although with similar readmission and mortality outcomes. 22 Improving prescription of MOUD during hospitalizations for severe infections may reduce early patient-directed discharge 23 and post-discharge mortality, 24 although many studies have reported difficulty improving the rate of MOUD use even with dedicated programs. 25 , 26 …”

Section: Discussionmentioning

confidence: 99%

Medication for opioid use disorder at hospital discharge is not associated with intravenous antibiotic completion in post-acute care facilities

Traver

Ching

Narayanan

2022

Therapeutic Advances in Infection

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Background: People with opioid use disorder and severe infections may complete their prolonged courses of outpatient parenteral antimicrobial therapy at a post-acute care facility due to adherence and safety concerns. We hypothesized that treatment with medications for opioid use disorder, such as methadone and buprenorphine, would increase antibiotic completion in these facilities. Methods: We performed a retrospective cohort study of people with opioid use disorder and severe infections who were discharged from the University of Maryland Medical Center to a post-acute care facility to complete intravenous antibiotic therapy. The primary outcome was completion of outpatient parenteral antimicrobial therapy. We compared the rate of antibiotic completion between patients prescribed and not prescribed medication for opioid use disorder at discharge from the acute care hospital. Results: A total of 161 patient encounters were included; the mean age was 43.4 years and 56% of patients were male. In 48% of the encounters, the patient was homeless and in 68% they recently injected drugs. The most common infectious syndrome was osteoarticular (44.1%). Medication for opioid use disorder was prescribed at discharge in 103 of 161 encounters and was newly started in 27 encounters. Similar rates of outpatient parenteral antimicrobial therapy completion were found in those who received (65/103) and did not receive (33/58) medication for opioid use disorder at discharge (odds ratio: 1.29; 95% confidence interval: 0.68–2.54; p = 0.44). Conclusion: Medication for opioid use disorder prescription at discharge was not associated with completion of outpatient parenteral antimicrobial therapy in a post-acute care facility. Our study is limited by possible selection bias and infrequent initiation of medication for opioid use disorder, which may have minimized the effect on antibiotic completion.

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Partial-Oral Antibiotic Therapy for Bone and Joint Infections in People With Recent Injection Drug Use

Yang

Dombrowski

Glick

et al. 2023

Open Forum Infectious Diseases

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Background Limited outcome data exists regarding partial-oral antibiotic therapy, defined as oral antibiotics as part of a patient’s treatment, for bone and joint infections (BJI) in people who inject drugs (PWID). Methods We conducted a retrospective study of all PWID reporting drug use within three months and BJI requiring six or more 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 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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A Novel Program to Provide Drug Recovery Assistance and Outpatient Parenteral Antibiotic Therapy in People Who Inject Drugs

Cited by 5 publications

References 19 publications

A Baker’s Dozen of Top Antimicrobial Stewardship Intervention Publications in Non–Hospital Care Settings in 2021

A Baker’s Dozen of Top Antimicrobial Stewardship Intervention Publications in Non–Hospital Care Settings in 2021

Medication for opioid use disorder at hospital discharge is not associated with intravenous antibiotic completion in post-acute care facilities

Partial-Oral Antibiotic Therapy for Bone and Joint Infections in People With Recent Injection Drug Use

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