Outpatient Parenteral Antimicrobial Therapy in Vulnerable Populations— People Who Inject Drugs and the Homeless

Abstract

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.

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

“…While the readmission rate in our cohort seems high, 85% of episodes included current/recent PWID, and prior studies of PWID receiving OPAT have documented similarly high rates of readmissions, ranging from 0.6% to 30%, with many >20% [ 6 ]. Additionally, we experienced a high loss to follow-up rate, which has been previously described among PWID who are also experiencing homelessness [ 13 ].…”

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

“…The appropriateness for home OPAT in PWID is an area of active debate. There are examples of success with home OPAT in this population, but many physicians remain uncomfortable with PICCs and home OPAT in PWID [ 22 ]. If a patient has demonstrated a pattern of non-adherence and injurious behavior, PICC and even SNF placement may be viewed as unacceptable options given the risk of treatment failure and further morbidity and mortality.…”

Dalbavancin as Secondary Therapy for Serious Staphylococcus aureus Infections in a Vulnerable Patient Population

“…Unfortunately, this low rate of engagement in care and follow-up is common among PWUD [7, 16] and highlights the challenges in caring for this population. Among 101 housed and homeless PWID receiving OPAT without dalbavancin from our institution, we note a similar rate of clinical cure (49%) and a high rate of unknown outcome (47%) due to loss to follow-up [17].…”