Infectious Diseases Physicians’ Perspectives Regarding Injection Drug Use and Related Infections, United States, 2017

Rapoport, Alison B; Fischer, Leah S.; Santibañez, Scott; Beekmann, Susan E.; Polgreen, Philip M.; Rowley, Christopher F

doi:10.1093/ofid/ofy132

Cited by 62 publications

(61 citation statements)

References 11 publications

(11 reference statements)

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“…As was apparent in our study, prolonged hospitalizations for rIE are common as these infections are severe and parenteral therapy is standard of care for IE [29, 30]. 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].…”

Section: Discussionmentioning

confidence: 99%

“…The summative costs of all episodes of endocarditis for this population of 22 individuals (1 patient had 5 endocarditis admissions), which occurred over a span of 5 years, exceeded $8 million. This cost represents an enormous economic burden for these patients and their families, as well as for the institutions that provide care to this frequently underinsured group of patients [37]. …”

Section: Discussionmentioning

confidence: 99%

“…In response to this crisis, our institution is working to expand its addiction treatment capabilities. However, this initiative remains a work in progress in our region and elsewhere as states are facing challenges from similar inadequate infrastructure [37, 39]. …”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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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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“…Many transplant centers consider OUDs, chronic opioid use, or opioid agonist treatment to be a relative contraindication to proceeding with transplantation [113][114][115]. Similarly, people with a history of injection drug use, or people on opioid agonist treatment (irrespective of injection drug use history), are routinely excluded from receiving post-acute care in skilled nursing facilities [116] or parenteral antimicrobial therapy in outpatient settings [117,118]. Physicians identified as having OUDs who are required to enroll in physician health programs are often required to adhere to abstinence-only approaches and discontinue opioid agonist treatment as a condition of maintaining professional licensure [119].…”

Section: Structural Stigmamentioning

confidence: 99%

Stigma as a fundamental hindrance to the United States opioid overdose crisis response

et al. 2019

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• The current United States opioid overdose crisis is a complex, multifaceted, public health emergency that urgently requires the implementation of evidence-based primary, secondary, and tertiary preventive interventions. We develop a typology of the stigma related to opioid use, showing how multiple dimensions of stigma continue to fundamentally hinder the response to the crisis. • Public stigma is driven by stereotypes about people with opioid use disorders, such as their perceived dangerousness or perceived moral failings, which translate into negative attitudes toward people with opioid use disorders. • Enacted stigma describes the behavioral manifestations of public stigma, including discrimination and social distancing. Public and enacted stigma, in turn, lead to delivery of suboptimal care and undermine access to treatment and harm reduction services. • Public stigma and enacted stigma can become structural stigma when they become encoded in cultural norms, laws, and institutional policies. Collectively, these forms of stigma run at cross purposes to-and reduce public support for-public health-oriented policies to address the opioid overdose crisis.

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“…Many practitioners believe that IDU is an absolute contraindication to the use of peripherally inserted central catheters (PICC) for administration of antimicrobials; however, evidence of harm is lacking. 25,26 In a review of outpatient parenteral antimicrobial therapy (OPAT) in patients with IDU, there were low overall rates of line-related adverse events and no significant difference in complications between IDU and non-IDU patients receiving OPAT. 27 As with any medical intervention, risks and benefits must be balanced.…”

Section: Is It Safe To Place a Peripherally Inserted Central Cathetermentioning

confidence: 99%

New Answers for Old Questions in the Treatment of Severe Infections from Injection Drug Use

Serota

Vettese

2019

Journal of Hospital Medicine

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A s a result of the epidemic of opioid use disorder (OUD), there has been a secondary surge in hospitalizations for infectious complications of injection drug use (IDU). 1,2 In the previous 10 years, there have been significant increases in IDU-associated human immunodeficiency virus (HIV) 3 and hepatitis C virus (HCV) 4 infection as well as increased hospitalizations from IDU-associated skin and soft tissue infections, osteomyelitis, septic arthritis, bacteremia, fungemia, and infective endocarditis in the United States. 2,[5][6][7] Patients admitted with IDU-associated infections have long lengths of stay, high rates of leaving against medical advice (AMA), readmission, and mortality. [8][9][10][11][12][13] In a British cohort (median age 36 years), five-year mortality after an episode of IDU-associated endocarditis was 42%. 14 Admissions for IDU-associated infections can be a troubling experience for both patients and providers alike. 15 While management decisions of IDU-associated infectious syndromes have sometimes been based on emotion, dogma, and an often-stigmatizing approach toward people suffering from addiction, 16 with a better understanding of addiction and effective treatments, as well as accumulating data in both addiction and infectious disease fields, it is an appropriate time to reevaluate the approach to treatment.The goal of this review is to examine recent evidence and attempt to answer questions that frequently arise in the management of hospitalized patients with IDU-associated infections. The questions addressed in this review primarily stem from the discussion of Schranz and colleagues in their description of increasing hospitalizations for IDU-associated endocarditis. 7 Additionally, questions were developed from discussions with practicing academic hospitalists. For each question, a review of the published literature was performed, with a focus on articles published between 2014 and 2019. Finally, a framework for how to approach patients with infectious complications of IDU is presented. As a comprehensive review of infectious complications of OUD would be difficult to cover in one review, this review will focus on eight questions that frequently arise in the care of inpatients.

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Infectious Diseases Physicians’ Perspectives Regarding Injection Drug Use and Related Infections, United States, 2017

Cited by 62 publications

References 11 publications

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

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

Stigma as a fundamental hindrance to the United States opioid overdose crisis response

New Answers for Old Questions in the Treatment of Severe Infections from Injection Drug Use

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