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

Abstract

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.

“Once more, with feeling”: no difference in outcomes between patients discharged on oral versus intravenous antibiotics for orthopedic infections in a propensity score matched cohort at a US medical center

“…Several institutions have previously published their experience using oral antibiotics, either to treat orthopedic infections in general 13 , 14 , 23 or in specific situations. 24 – 26 Similar to the current study, many of these institutions made a concerted effort to consider oral antibiotics for the treatment of orthopedic infections and saw a subsequent increase in the proportion of patients discharged on oral antibiotics. Also similar to the current study, no studies have found any increased risk of treatment failure when using PO versus IV antibiotics.…”

Stimulant Co-use Is Associated With Patient-directed Discharges in Hospitalized Patients with Opioid Use and Injection Drug Use Related Infections

“…Details of this cohort were previously published. 5 Demographics, recent substance use, and treatment outcomes were determined via review by a single coder of clinical notes from infectious diseases, addiction medicine, and/or admitting team. t Tests and χ 2 tests were used to compare demographics between opioid and stimulant co-use versus opioid-only.…”

“…Patients were admitted to a university-affiliated urban teaching hospital in King County, Washington, throughout a 2-year study period (2019–2021). Details of this cohort were previously published 5 . Demographics, recent substance use, and treatment outcomes were determined via review by a single coder of clinical notes from infectious diseases, addiction medicine, and/or admitting team.…”