Outpatient Antimicrobial Treatment for People Who Inject Drugs

Hurley, Hermione; Sikka, Monica K; Jenkins, Timothy C; Cari, Evelyn Villacorta; Thornton, Alice

doi:10.1016/j.idc.2020.06.009

Cited by 12 publications

(5 citation statements)

References 45 publications

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“…Other studies have tried to identify interventions to improve adherence and completion of antibiotics among this population. Hurley et al published an informative review article regarding outpatient antibiotic therapy in PWID [ 15 ]. They documented components of successful treatment completion, such as evaluation of the home environment, staff education, a multidisciplinary approach, patient engagement, harm reduction practices, and the need for ongoing family/social support for patients.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Bundled Interventions for Patients With Opioid Use Disorder Experiencing Homelessness Receiving Extended Antibiotics for Severe Infection

Beieler

Klein

Bhatraju

et al. 2021

Open Forum Infectious Diseases

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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).

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Section: Discussionmentioning

confidence: 99%

Evaluation of Bundled Interventions for Patients With Opioid Use Disorder Experiencing Homelessness Receiving Extended Antibiotics for Severe Infection

Beieler

Klein

Bhatraju

et al. 2021

Open Forum Infectious Diseases

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“…Finally, hospitals and home care agencies should consider outpatient IV antibiotics, given increasing evidence that in certain populations, outpatient parenteral therapy combined with medications for OUD shortens hospital length of stay, obviates the need for SNFs, and has high completion rates. 29,30…”

Section: Discussionmentioning

confidence: 99%

“…Our study also suggests that hospitalists should be comfortable initiating buprenorphine to manage untreated patients with OUD, as beyond the treatment benefits, it is also associated with better rates of SNF placement. Finally, hospitals and home care agencies should consider outpatient IV antibiotics, given increasing evidence that in certain populations, outpatient parenteral therapy combined with medications for OUD shortens hospital length of stay, obviates the need for SNFs, and has high completion rates 29,30 …”

Section: Discussionmentioning

confidence: 99%

The association between opioid use disorder and skilled nursing facility acceptances: A multicenter retrospective cohort study

Kuye,

Prichett,

Stewart

et al. 2024

Journal of Hospital Medicine

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BackgroundPrior single‐hospital studies have documented barriers to acceptance that hospitalized patients with opioid use disorder (OUD) face when referred to skilled nursing facilities (SNFs).ObjectiveTo examine the impact of OUD on the number of SNF referrals and the proportion of referrals accepted.Design, Settings, and ParticipantsA retrospective cohort study of hospitalizations with SNF referrals in 2019 at two academic hospitals in Baltimore, MD.ExposureOUD status was determined by receipt of medications for OUD during admission, upon discharge, or the presence of a diagnosis code for OUD.Key ResultsThe cohort included 6043 hospitalizations (5440 hospitalizations of patients without OUD and 603 hospitalizations of patients with OUD). Hospitalizations of patients with OUD had more SNF referrals sent (8.9 vs. 5.6, p < .001), had a lower proportion of SNF referrals accepted (31.3% vs. 46.9%, p < .001), and were less likely to be discharged to an SNF (65.6% vs. 70.3%, p = .003). The effect of OUD status on the number of SNF referrals and the proportion of referrals accepted remained significant in multivariable analyses. Our subanalysis showed that reduced acceptances were driven by the hospitalizations of patients discharged without medications for OUD and those receiving methadone. Hospitalizations of patients discharged on buprenorphine were accepted at the same rates as hospitalizations of patients without OUD.ConclusionsThis multicenter retrospective cohort study found that hospitalizations of patients with OUD had more SNF referrals sent and fewer referrals accepted. Further work is needed to address the limited discharge options for patients with OUD.

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“…Patients with SIRI typically are asked to stay in the hospital for the duration of IV antibiotic therapy, but some may be discharged to complete IV antibiotics in a skilled nursing facility, residential addiction treatment setting, or may be discharged without a PICC on partial oral or long-acting injectable lipoglycopeptide antibiotic therapy. 18 , 19 The clinical landscape of OUD and SIRI is changing rapidly, and this inclusive approach to the TAU arm provides greater external validity and generalizability.…”

Section: Methodsmentioning

confidence: 99%

Design and protocol of the Buprenorphine plus Outpatient Parenteral Antimicrobial Therapy (B-OPAT) study: a randomized clinical trial of integrated outpatient treatment of opioid use disorder and severe, injection-related infections

Fanucchi

Murphy

Surratt

et al. 2022

Therapeutic Advances in Infection

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Introduction: A marked increase in hospitalizations for severe, injection-related infections (SIRI) has been associated with the opioid epidemic. Outpatient parenteral antibiotic therapy (OPAT) is typically not offered to persons with opioid use disorder (OUD) and SIRI, though increasing evidence suggests it may be feasible and safe. This study evaluates the efficacy and cost-effectiveness of an integrated care model combining Buprenorphine treatment of OUD with OPAT for SIRI (B-OPAT) compared with treatment as usual on key OUD, infectious disease, and health economic outcomes. B-OPAT expands and incorporates key elements of established clinical models, including inpatient initiation of buprenorphine for OUD, inpatient infectious disease consultation for SIRI, office-based treatment of OUD, and OPAT, and includes more frequent clinical outpatient visits than standard OPAT. A qualitative evaluation is included to contextualize effectiveness outcomes and identify barriers and facilitators to intervention adoption and implementation. Methods: B-OPAT is a single-site, randomized, parallel-group, superiority trial recruiting 90 adult inpatients hospitalized with OUD and SIRI who require at least 2 weeks of intravenous (IV) antibiotic therapy. After screening, eligible participants are randomized 1:1 to either discharge once medically stable to an integrated outpatient treatment care model combining Buprenorphine and OPAT (B-OPAT) or to Treatment As Usual (TAU). The primary outcome measure is the proportion of urine samples negative for illicit opioids in the 12 weeks after discharge from the hospital. Key secondary OUD outcomes include self-reported number of days of illicit opioid abstinence and 12-week retention in buprenorphine treatment. The infection outcomes are completion of recommended IV antibiotic therapy, peripherally inserted central catheter (PICC) complications, and readmission related to primary SIRI. Conclusions: The B-OPAT study will help address the important question of whether it is clinically effective and cost-effective to discharge persons with OUD and SIRI to an integrated outpatient care model combining OUD treatment with OPAT relative to TAU (Clinicaltrials.gov Identifier: NCT04677114).

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Outpatient Antimicrobial Treatment for People Who Inject Drugs

Cited by 12 publications

References 45 publications

Evaluation of Bundled Interventions for Patients With Opioid Use Disorder Experiencing Homelessness Receiving Extended Antibiotics for Severe Infection

Evaluation of Bundled Interventions for Patients With Opioid Use Disorder Experiencing Homelessness Receiving Extended Antibiotics for Severe Infection

The association between opioid use disorder and skilled nursing facility acceptances: A multicenter retrospective cohort study

Design and protocol of the Buprenorphine plus Outpatient Parenteral Antimicrobial Therapy (B-OPAT) study: a randomized clinical trial of integrated outpatient treatment of opioid use disorder and severe, injection-related infections

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