Evaluation of Partial Oral Antibiotic Treatment for Persons Who Inject Drugs and Are Hospitalized With Invasive Infections

Marks, Laura R.; Liang, Stephen Y.; Muthulingam, Dharushana; Schwarz, Evan S.; Liss, David B.; Munigala, Satish; Warren, David K.; Durkin, Michael J.

doi:10.1093/cid/ciaa365

Cited by 48 publications

(43 citation statements)

References 27 publications

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“…Patients with endocarditis, considered to be the most complicated infection of those evaluated—and universally fatal if untreated, were also most likely to leave the hospital prior to completing treatment. Many patients with IDU-associated infections and patient-directed discharge do not receive oral antibiotics to complete their treatment [ 11 ]; in one study, those who did not receive oral antibiotics upon patient-directed discharge had a 90-day readmission rate more than double of those with patient-directed discharge who did have an antibiotic prescribed (69% versus 33%) [ 39 ]. Avoidance of patient-directed discharge should be a top priority for patients with IDU-associated infections.…”

Section: Discussionmentioning

confidence: 99%

Evaluating Differences in Opioid and Stimulant Use-associated Infectious Disease Hospitalizations in Florida, 2016–2017

Serota

Bartholomew

Tookes

2020

Clinical Infectious Diseases

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Background The opioid epidemic has led to increases in injection drug use (IDU)-associated infectious diseases; however, little is known about how more recent increases in stimulant use have affected the incidence and outcomes of hospitalizations for infections among people who inject drugs (PWID). Methods All hospitalizations of PWID for IDU-associated infections in Florida were identified using administrative diagnostic codes and were grouped by substance used (opioids, stimulants, or both) and site of infection. We evaluated the association between substance used and the outcomes: patient-directed discharge (PDD, or “against medical advice”) and in-hospital mortality. Results There were 22,856 hospitalizations for infections among PWID. Opioid use was present in 73%, any stimulants in 43%, and stimulants-only in 27%. Skin and soft tissue infection was present in 50%, sepsis/bacteremia in 52%, osteomyelitis in 10%, and endocarditis in 10%. PWID using opioids/stimulants were youngest, most uninsured, had the highest rate of endocarditis (16%) and hepatitis C (44%). Additionally, 25% of opioid/stimulant users had PDD versus 12% for those using opioids-only. In adjusted models, opioid/stimulant use was associated with PDD compared to opioid-only use (aRR 1.28, 95% CI 1.17-1.40). Younger age and endocarditis were also associated with PDD. Compared to opioid-only use, stimulant-only use had higher risk of in-hospital mortality (aRR 1.26, 95% CI 1.03-1.46). Conclusion While opioid use contributed to most IDU-associated infections, many hospitalizations also involved stimulants. Increasing access to harm reduction interventions could help prevent these infections, while further research on the acute management of stimulant use disorder-associated infections is needed.

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Section: Discussionmentioning

confidence: 99%

Evaluating Differences in Opioid and Stimulant Use-associated Infectious Disease Hospitalizations in Florida, 2016–2017

Serota

Bartholomew

Tookes

2020

Clinical Infectious Diseases

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“…Additionally, even partial treatment may be better than none; one study in PWID leaving AMA showed that receipt of sub-par oral antimicrobials for invasive infections resulted in lower readmission rates [ 28 ]. Furthermore, dalbavancin confers the probable benefit of directly observed therapy, which is generally not possible for outpatient oral microbial regimens.…”

Section: Discussionmentioning

confidence: 99%

Dalbavancin in the Treatment of Bacteremia and Endocarditis in People with Barriers to Standard Care

2020

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Introduction: Dalbavancin is an antibiotic administered by intravenous infusion weekly or bi-weekly and is currently FDA-approved only for treatment of skin and soft-tissue infections. It has shown promise, but is not considered the standard of care, for bacteremia and infective endocarditis (IE), which typically require outpatient parenteral antibiotic therapy (OPAT) for prolonged durations. People who inject drugs (PWID) with bacteremia or IE are often perceived as having barriers to OPAT and standard daily-administered antibiotics, prompting off-label use of dalbavancin in this population. Methods: A retrospective review of adult patients receiving at least one dose of dalbavancin for bacteremia or IE was conducted between 1 November 2017 and 31 October 2019. Outcomes and reasons for use of dalbavancin were recorded, including specific barriers to standard therapy. Results: Stated reasons for dalbavancin use in the 18 patients identified included active injection drug use (50%), inability to arrange standard OPAT due to patient adherence or inability to place in skilled nursing facility (SNF) (22%), risk for additional infections or other morbidity with OPAT (22%), and patient preference (6%). In 11 patients (61%) SNF placement was not attempted due to behavioral issues or patient declination. There were five patients who did not complete their intended course of treatment (28%). At 90 days, eight patients (44%) achieved a clinical or biologic cure, six (33%) failed treatment, and four (22%) were lost to follow-up. Conclusion: Dalbavancin may have a role as salvage therapy in the treatment of IE and bacteremia in PWID who have significant barriers to standard treatment.

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“…Although recent randomized trials have demonstrated that oral antibiotics are effective for bone and joint infections and endocarditis, these studies have included few patients with substance use disorders, and concerns about nonadherence may limit use of oral therapy in this population [ 5 , 6 ]. A recent retrospective study showed similar readmission rates among PWID with invasive infections who completed inpatient parenteral therapy and those who received partial oral therapy, but published evidence with oral therapy in this population remains scarce [ 7 ]. Novel care models to successfully treat these patients while shortening durations of hospitalization are urgently needed.…”

Section: Introductionmentioning

confidence: 99%

Use of a Standardized Dalbavancin Approach to Facilitate Earlier Hospital Discharge for Vulnerable Patients Receiving Prolonged Inpatient Antibiotic Therapy

Deida

Shihadeh

Preslaski

et al. 2020

Open Forum Infectious Diseases

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Evaluation of Partial Oral Antibiotic Treatment for Persons Who Inject Drugs and Are Hospitalized With Invasive Infections

Cited by 48 publications

References 27 publications

Evaluating Differences in Opioid and Stimulant Use-associated Infectious Disease Hospitalizations in Florida, 2016–2017

Evaluating Differences in Opioid and Stimulant Use-associated Infectious Disease Hospitalizations in Florida, 2016–2017

Dalbavancin in the Treatment of Bacteremia and Endocarditis in People with Barriers to Standard Care

Use of a Standardized Dalbavancin Approach to Facilitate Earlier Hospital Discharge for Vulnerable Patients Receiving Prolonged Inpatient Antibiotic Therapy

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