A 9-Point Risk Assessment for Patients Who Inject Drugs and Require Intravenous Antibiotics: Focusing Inpatient Resources on Patients at Greatest Risk of Ongoing Drug Use

Eaton, Ellen; Mathews, Ronnie; Lane, Peter S; Paddock, Cayce S; Rodríguez, Jorge Martin; Taylor, Benjamin; Saag, Michael S.; Kilgore, Meredith L.; Lee, Rachael A

doi:10.1093/cid/ciy722

Cited by 47 publications

(41 citation statements)

References 6 publications

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“…The success rate of people with IDU-associated infective endocarditis completing their treatment with home IV antibiotics, albeit a small number of select patients in this study, suggests that further research is needed on different medical models of outpatient antibiotic therapy in this population. Thus far, the use of a risk assessment tool to guide discharge decisions has been shown to help decreased length of stays and optimize resources for individuals with ongoing IDU that may remain hospitalized [24]. While a recent study suggested noninferiority of oral antibiotics compared with intravenous antibiotics for treatment of left sided infective endocarditis, PWID were vastly underrepresented (1.3% compared to 39% in our study population) [25].…”

Section: Discussionmentioning

confidence: 99%

Mortality, morbidity, and cardiac surgery in Injection Drug Use (IDU)-associated versus non-IDU infective endocarditis: The need to expand substance use disorder treatment and harm reduction services

et al. 2019

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BackgroundThe addiction crisis is widespread, and unsafe injection practices among people who inject drugs (PWID) can lead to infective endocarditis.MethodsA retrospective analysis of adult patients with definite or possible infective endocarditis admitted to a tertiary care center in Portland, Maine was performed over three-year period. Our primary objective was to examine differences in demographics, health characteristics, and health service utilization between injection drug use (IDU)-associated infective endocarditis and non-IDU infective endocarditis. The association between IDU and mortality, morbidity (defined as emergency department visits within 3 months of discharge), and cardiac surgery was examined. Bivariate and multivariate analyses were performed. A subgroup descriptive analysis of PWID was also performed to better examine substance use disorder (SUD) characteristics, treatment with medication for opioid use disorder (MOUD) and health service utilization.ResultsOne-hundred and seven patients were included in the study, of which 39.2% (n = 42) had IDU-associated infective endocarditis. PWID were more likely to be homeless, uninsured, and lack a primary care provider. PWID were notably younger and had less documented comorbidities, however had similar in-hospital mortality rates (10% vs. 14%, p = 0.30), ED visits (50% vs. 54%, p = 0.70) and cardiac surgery (33% vs. 26%, p = 0.42) compared to those with non-IDU infective endocarditis. Ninety-day mortality was less among PWID (19.0% vs. 36.9%, p = 0.05). IDU was not associated with morbidity (adjusted odds ratio (AOR) 0.73, 95% CI 0.18–3.36), 90-day mortality (AOR 0.72, 95% CI 0.17–3.01), or cardiac surgery (AOR 0.15, 95% CI 0.03–0.69). Ninety-day mortality among PWID who received MOUD was lower (3% vs 15%, p = 0.45), as were ED visits (10% vs. 41%, p = 0.42) compared to those who did not receive MOUD.ConclusionsOur results highlight existing differences in health characteristics and social determinants of health in people with IDU-associated versus non-IDU infective endocarditis. PWID had less comorbidities and were significantly younger than those with non-IDU infective endocarditis and yet still had similar rates of cardiac surgery, ED visits, and in-hospital mortality. These findings emphasize the need to deliver comprehensive health services, particularly MOUD and other harm reduction services, to this marginalized population.

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Section: Discussionmentioning

confidence: 99%

Mortality, morbidity, and cardiac surgery in Injection Drug Use (IDU)-associated versus non-IDU infective endocarditis: The need to expand substance use disorder treatment and harm reduction services

et al. 2019

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“…Not only are many physicians unwilling to discharge PWID home with intravenous access due to safety concerns, but practical barriers such as lack of home health services for this patient population also exist [37]. However, algorithms to identify patients who may be safely discharged home on outpatient parenteral antimicrobial therapy with central vascular catheters are now being developed [38]. The average total hospital costs for managing an episode of IE at our institution were ~$145 000, which is similar to previous studies [35].…”

Section: Discussionmentioning

confidence: 99%

Repeat Infective Endocarditis in Persons Who Inject Drugs: “Take Another Little Piece of my Heart”*

Huang

Barnes

Peacock

2018

Open Forum Infectious Diseases

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BackgroundInjection drug use (IDU) is a major risk factor for infective endocarditis (IE). Few data exist on repeat IE (rIE) in persons who inject drugs (PWID).MethodsPatients ≥18 years old seen at Wake Forest Baptist Medical Center from 2004 to 2017 who met Duke criteria for IE and who self-reported IDU in the 3 months before admission were identified. The subset of PWID who developed rIE, defined as another episode of IE at least 10 weeks after diagnosis of the first episode, was then reviewed.ResultsOf the 87 PWID who survived their first episode of IE, 22 (25.3%) experienced rIE and 77.3% had rIE within a year of the first episode. All patients who experienced rIE resumed IDU between episodes of IE. Of the patients with rIE, 54.5% had an infection caused by S. aureus and 22.7% required surgical intervention. Mortality at 1 year was 36.3%. Compared with their first IE episode, patients with rIE had fewer S. aureus infections (P = .01). Compared with PWID who experienced single-episode IE, intravenous prescription opioid use (P = .01), surgery (P < .01), tricuspid valve involvement (P = .02), and polymicrobial infection (P = .03) occurred more often during first episodes of IE in individuals who then developed rIE.ConclusionsrIE is common among IDU-related IE and confers a high 1-year mortality rate. The microbiology of rIE is varied, with S. aureus being less frequently isolated. More studies on modification of social and clinical risk factors are needed to prevent rIE.

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“…A literature review of 10 studies on OPAT in PWID 34 found high treatment completion, low mortality, and few catheter-related complications, comparable to rates in non-PWID populations. Another study 35 implemented a 9-point tool to identify PWID candidates for OPAT, with low-risk PWID discharged to complete treatment as outpatients. Implementation resulted in reduced length of stay and cost savings without increased readmissions.…”

Section: Discussionmentioning

confidence: 99%

Risk of New Bloodstream Infections and Mortality Among People Who Inject Drugs With Infective Endocarditis

et al. 2020

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IMPORTANCE People who inject drugs (PWID) who are being treated for infective endocarditis remain at risk of new bloodstream infections (BSIs) due to ongoing intravenous drug use (IVDU). OBJECTIVES To characterize new BSIs in PWID receiving treatment for infective endocarditis, to determine the clinical factors associated with their development, and to determine whether new BSIs and treatment setting are associated with mortality.

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A 9-Point Risk Assessment for Patients Who Inject Drugs and Require Intravenous Antibiotics: Focusing Inpatient Resources on Patients at Greatest Risk of Ongoing Drug Use

Cited by 47 publications

References 6 publications

Mortality, morbidity, and cardiac surgery in Injection Drug Use (IDU)-associated versus non-IDU infective endocarditis: The need to expand substance use disorder treatment and harm reduction services

Mortality, morbidity, and cardiac surgery in Injection Drug Use (IDU)-associated versus non-IDU infective endocarditis: The need to expand substance use disorder treatment and harm reduction services

Repeat Infective Endocarditis in Persons Who Inject Drugs: “Take Another Little Piece of my Heart”*

Risk of New Bloodstream Infections and Mortality Among People Who Inject Drugs With Infective Endocarditis

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