257. Staphylococcus aureus Bacteremia: Does Intravenous Drug Use Impact Quality of Care and Clinical Outcomes?

Abstract

Background Individuals with intravenous drug use (IDU) have higher risk for Staphylococcus aureus bacteremia (SAB) and increased management complexity. The goal of this study was to compare differences in SAB characteristics, adherence to standard of care metrics, and clinical outcomes in those with and without IDU. Methods A retrospective chart review was conducted on cases of SAB between January 1, 2016 and December 31, 2017 at a 500-bed teaching hospital. Inclusion criteria was age > 18 years and ≥ one blood culture positive for S. aureus. Patients were excluded if they transferred hospitals, had care withdrawn or died within 48 hours of diagnosis or had a ventricular assist device infection. Records were reviewed for substance use, SAB characteristics, standards of care, and outcomes. Data were analyzed using SPSS software. The study was approved by the Institutional Review Board. Results In 248 patients with SAB, 28.2% had documented IDU. Median age was 37 (IDU) and 57 (non-IDU). In the IDU group, 75.7% had the formal diagnosis of opioid use disorder and 78.9% of stimulant use disorder. IDU was associated with hepatitis C and houselessness while non-IDU was associated with diabetes, hemodialysis, and cancer. Those with IDU had higher rates of MRSA, endocarditis, and spinal infections, but did not have higher rates of polymicrobial infections or venous thrombosis. There was no difference in appropriate repeat blood cultures, antibiotic management, and ID consultation. Length of stay and against medical advice (AMA) discharges were higher in those with IDU. There was no difference in 90-day recurrence or readmission, but 90-day mortality was higher in the non-IDU group. Conclusion There was no difference in adherence to SAB quality of care metrics between groups with and without IDU. Despite the IDU group being younger with fewer comorbidities, 90-day readmissions were not different between groups. This bears further analysis but may represent the influence of therapy completion, AMA discharges, and unmeasured social determinants of health. Disclosures All Authors: No reported disclosures

Community-Acquired Staphylococcus aureus Bacteremia Among People Who Inject Drugs: A National Cohort Study in England, 2017–2020

“…PWID were more likely to have endocarditis, SSTI, and pneumonia, consistent with single-center studies [ 18 , 19 ]. For example, McClellan et al reported that, among hospitalized patients with SAB, PWID had higher rates of IE (31.4% vs 8.5%, P < .001) and of SSTI (25.7% vs 14.8%, P = .02) than non-PWID [ 19 ].…”

“…The age of PWID in this study was younger than non-PWID patients, consistent with a median age of 41 years (IQR, 36–48 years) for the PWID population in England [ 6 , 34 ]. This may account for the lower prevalence of medical comorbidities observed among PWID, as has been reported previously [ 19 ]. Diabetes, HIV, CKD, and malignancy have been associated with increased risk of recurrent infection and death following SAB [ 12 , 13 , 33 ].…”

“…Only 1 previous study made direct comparisons of clinical outcomes in PWID and non-PWID patients with CA-SAB. This was a single-center study by McClellan et al of 248 patients in Oregon, US [ 19 ]. The authors reported a weak trend toward lower risk of 90-day mortality (4.3% vs 9.6%, P = .170) and increased risk of readmission within 90 days (46.3% vs 39.8%, P = .154) among PWID compared to non-PWID patients.…”

“…One study based in London noted that PWID had frequent hospital admissions (up to 12 over a 4-year period) [ 18 ]. PWID have also been reported to have high rates of discharge from hospital against medical advice—25.7% in PWID versus 1.1% in non-PWID in a US study and 15% in PWID in a UK study [ 16 , 19 ]. However, we observed a lower risk of readmission among PWID possibly because LOS was slightly longer for PWID as was reported by McClellan et al [ 19 ].…”

“…PWID have also been reported to have high rates of discharge from hospital against medical advice—25.7% in PWID versus 1.1% in non-PWID in a US study and 15% in PWID in a UK study [ 16 , 19 ]. However, we observed a lower risk of readmission among PWID possibly because LOS was slightly longer for PWID as was reported by McClellan et al [ 19 ]. In the UK, CA-SAB is generally treated in hospital with intravenous (IV) antibiotics for a minimum of 2 weeks, after which patients requiring longer courses can complete IV therapy via outpatient parenteral antibiotic therapy (OPAT) [ 29 ].…”