Impact of medications for opioid use disorder among persons hospitalized for drug use-associated skin and soft tissue infections

Abstract

Background: Skin and soft tissue infections (SSTI) are common complications of injection drug use. We aimed to determine if rehospitalization and recurrent SSTI differ among persons with opioid use disorder (OUD) hospitalized for SSTI who are initiated on MOUD within 30 days of discharge and those who are not. Methods:We performed a retrospective analysis of commercially insured adults aged 18 years and older in the U.S. with OUD and hospitalization for injection-related SSTI from 2010-2017. The primary exposure was initiation of MOUD in the 30 days following hospitalization for SSTI. The primary outcomes included 30-day and 1-year 1) all-cause rehospitalization and 2) recurrent SSTI. We calculated the incidence rates for the two groups: MOUD group and no MOUD group for the primary outcomes. We developed Cox models to determine if rehospitalization and recurrent SSTI differ between the two groups.Results: Only 5.5% (357/6538) of people received MOUD in the month following their index SSTI hospitalization. 30-day rehospitalization incidence was higher in the MOUD group compared to no MOUD (35.9 vs 27.5 per 100 person-30 days) and one-year SSTI recurrence was lower (10.3 vs 18.7 per 100 person-years). In multivariable modeling, the MOUD group remained at significantly higher risk of 30-day rehospitalization compared to the no MOUD group and at lower risk for one-year SSTI recurrence.

Harm reduction for the treatment of patients with severe injection-related infections: description of the Jackson SIRI Team

“…Compared to other cohorts of patients with SIRI, the 100% rate of post-discharge MOUD is especially notable. National US cohorts have demonstrated <10% receipt of MOUD following SIRI hospitalization [ 37 , 38 ] and even in select locales with higher addiction treatment access, only 25–50% of patients with SIRI receive post-hospital MOUD [ 10 , 39 ]. We believe that the control of cravings and withdrawal facilitated high rates of antibiotic completion in a group of individuals who had previously struggled immensely with adherence to medical care.…”

Opioid agonist treatment and risk of death or rehospitalization following injection drug use–associated bacterial and fungal infections: A cohort study in New South Wales, Australia

“…We included OATS study participants who survived at least one emergency (unplanned) hospitalization with skin and soft-tissue infection, sepsis or bacteremia, endocarditis, osteomyelitis, septic arthritis, or central nervous system infections (brain or spine abscess), identified using ICD-10 codes (see Fig 1 for study inclusion flow diagram; see S1 Table for ICD codes). We began with codes used in prior studies [ 8 , 29 , 39 – 41 ] and adapted our final list based on literature review and clinical input from the investigator team.…”

“…Prior analyses of potential benefits of OAT after hospitalization with injecting-related infections have been limited by small sample sizes with wide confidence intervals (CIs) [ 38 , 39 ]. Three administrative linkage cohort studies (all from US insurance claims data) have assessed associations between use of OAT and outcomes after hospitalization with injecting-related bacterial or fungal infections [ 39 – 41 ]. One study identified a reduced risk of death after hospitalizations with injecting-related endocarditis, but did not assess rehospitalizations [ 40 ].…”

“…A second study identified no significant effect (with wide CIs) on risk of rehospitalization after endocarditis and did not assess mortality [ 39 ]. A third identified a reduced risk of rehospitalization for skin and soft-tissue infections at 1 year [ 41 ]. Reflecting suboptimal access, use of OAT (or of naltrexone, an opioid antagonist medication used for opioid use disorder treatment in the US) was reported as 24% within 3 months following hospital discharge in the first study [ 40 ] and as 6% within 30 days following discharge in the second and third studies [ 39 , 41 ].…”

“…A third identified a reduced risk of rehospitalization for skin and soft-tissue infections at 1 year [ 41 ]. Reflecting suboptimal access, use of OAT (or of naltrexone, an opioid antagonist medication used for opioid use disorder treatment in the US) was reported as 24% within 3 months following hospital discharge in the first study [ 40 ] and as 6% within 30 days following discharge in the second and third studies [ 39 , 41 ]. The latter 2 studies also only included information on buprenorphine use, as they did not have access to insurance claims or prescribing records for methadone.…”