Feasibility and Safety of Outpatient Parenteral Antimicrobial Therapy in Conjunction With Addiction Treatment for People Who Inject Drugs

Price, Christin N; Solomon, Daniel A.; Johnson, Jennifer A.; Montgomery, Mary W; Martin, Bianca; Suzuki, Joji

doi:10.1093/infdis/jiaa025

Cited by 39 publications

(39 citation statements)

References 10 publications

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“…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. Recently Price et al documented successful OPAT in selected housed PWID with close follow-up and additional support through a devoted clinic, with weekly visits and linkage to MOUD [ 16 , 17 ]. This program allowed for more flexibility in appropriate inpatient discharges, avoiding 570 inpatient bed days.…”

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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“…First, providers may not consider PWID candidates for outpatient parenteral antibiotic therapy (OPAT), thus, prolonging hospital lengths of stay for infections that may require 2–6 weeks of intravenous antimicrobials. Although emerging data indicate that injection drug use is not a contraindication to OPAT and that PWID can be successfully and safely treated in the outpatient setting, these data had likely not yet impacted practice in our study period [ 42 , 43 ]. Second, due to fear of discrimination and judgment by healthcare providers, PWID with SBI may present to care later than people who do not inject drugs [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

Population-based trends in hospitalizations due to injection drug use-related serious bacterial infections, Oregon, 2008 to 2018

Capizzi

Leahy

Wheelock³

et al. 2020

PLoS ONE

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Background Injection drug use has far-reaching social, economic, and health consequences. Serious bacterial infections, including skin/soft tissue infections, osteomyelitis, bacteremia, and endocarditis, are particularly morbid and mortal consequences of injection drug use. Methods We conducted a population-based retrospective cohort analysis of hospitalizations among patients with a diagnosis code for substance use and a serious bacterial infection during the same hospital admission using Oregon Hospital Discharge Data. We examined trends in hospitalizations and costs of hospitalizations attributable to injection drug use-related serious bacterial infections from January 1, 2008 through December 31, 2018. Results From 2008 to 2018, Oregon hospital discharge data included 4,084,743 hospitalizations among 2,090,359 patients. During the study period, hospitalizations for injection drug use-related serious bacterial infection increased from 980 to 6,265 per year, or from 0.26% to 1.68% of all hospitalizations (P<0.001). The number of unique patients with an injection drug use-related serious bacterial infection increased from 839 to 5,055, or from 2.52% to 8.46% of all patients (P<0.001). While hospitalizations for all injection drug use-related serious bacterial infections increased over the study period, bacteremia/sepsis hospitalizations rose most rapidly with an 18-fold increase. Opioid use diagnoses accounted for the largest percentage of hospitalizations for injection drug use-related serious bacterial infections, but hospitalizations for amphetamine-type stimulant-related serious bacterial infections rose most rapidly with a 15-fold increase. People living with HIV and HCV experienced increases in hospitalizations for injection drug use-related serious bacterial infection during the study period. Overall, the total cost of hospitalizations for injection drug use-related serious bacterial infections increased from $16,305,129 in 2008 to $150,879,237 in 2018 (P<0.001). Conclusions In Oregon, hospitalizations for injection drug use-related serious bacterial infections increased dramatically and exacted a substantial cost on the health care system from 2008 to 2018. This increase in hospitalizations represents an opportunity to initiate substance use disorder treatment and harm reduction services to improve outcomes for people who inject drugs.

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“…PWID may benefit from increased engagement, follow-up, and access to care, as well as preventive interventions to reduce the need for hospitalization and emergency care, and to maximize treatment adherence [ 17 , 28 ]. This could include the provision of primary care medical services for early identification of lesions and treatment of patients within the community, rather than requiring hospital admission [ 29 , 30 ]. In one study that used a “package intervention” approach to facilitate treatment of PWID in an outpatient setting, 97% of patients were compliant with the entire duration of therapy [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Omadacycline Versus Linezolid in Acute Bacterial Skin and Skin Structure Infections in Persons Who Inject Drugs

2022

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Introduction: Acute bacterial skin and skin structure infections (ABSSSI) represent one of the most common reasons for emergency department visits, and are frequent complications of intravenous drug use in persons who inject drugs (PWID). This study examined the efficacy and safety of omadacycline, versus linezolid, in PWID and persons who do not inject drugs, in the Phase 3 Omadacycline in Acute Skin and Skin Structure Infection (OASIS-1, OASIS-2) studies. Methods: Eligible participants were aged C 18 years with qualifying skin infections: wound infection, cellulitis, erysipelas, or major abscess. The primary efficacy endpoint was early clinical response (ECR) in the modified intent-to-treat (mITT) population, defined as survival with C 20% reduction in lesion size at 48-72 h after the first dose of omadacycline or linezolid. Key secondary endpoints included investigatorassessed clinical response at the post-treatment evaluation (PTE) in the mITT and clinical perprotocol populations, and clinical response at PTE in the micro-mITT population. Safety was assessed based on adverse events (AEs) and standard clinical laboratory tests. Efficacy endpoints of clinical response at ECR and PTE were analyzed for the mITT and clinically evaluable (CE) PTE populations. Results: In total, 1380 patients (822 PWID, 558 non-PWID) were included in this secondary analysis. Wound infections were reported more frequently in the PWID subgroup (72.8%) at baseline; cellulitis or erysipelas (43.9%) and major abscess (37.4%) were the most frequently reported baseline infections in the non-PWID subgroup. Clinical success rates at ECR and PTE in the mITT population, and at PTE in the CE population, were high for patients receiving omadacycline or linezolid. Severe or serious treatment-emergent AEs (TEAEs), and TEAEs leading to discontinuation, were infrequent. Conclusion: This subgroup analysis showed that omadacycline was effective and well tolerated, regardless of PWID status.

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Feasibility and Safety of Outpatient Parenteral Antimicrobial Therapy in Conjunction With Addiction Treatment for People Who Inject Drugs

Cited by 39 publications

References 10 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

Population-based trends in hospitalizations due to injection drug use-related serious bacterial infections, Oregon, 2008 to 2018

Efficacy and Safety of Omadacycline Versus Linezolid in Acute Bacterial Skin and Skin Structure Infections in Persons Who Inject Drugs

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