Injection Drug Use and Infectious Disease Practice: A National Provider Survey

Rapoport, Alison B; Beekmann, Susan E.; Polgreen, Philip M.; Rowley, Christopher F

doi:10.1093/ofid/ofx163.810

Cited by 4 publications

(3 citation statements)

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“…When surveyed about the safety of OPAT for PWID, opinions among clinicians were mixed. Just over half of the respondents (56%) agreed with the following statement: “It is less safe and successful than non-IVDUs but benefits outweigh risks.” Conversely, only 16.0% of clinicians agreed with the statement “It is not safe and the whole system concerns me.” In a survey study of 672 ID physicians in the United States, confidence and acceptance of OPAT for PWID were found to be low, despite a high frequency of caring for patients with infections related to IDU [ 9 , 26 ]. Of those surveyed, 88% reported caring for at least 1 patient with IDU-related infections every month, but few indicated that they would provide OPAT for PWID.…”

Section: Discussionmentioning

confidence: 99%

Outpatient Parenteral Antimicrobial Therapy Among People Who Inject Drugs: A Review of the Literature

Suzuki

Johnson

Montgomery

et al. 2018

Open Forum Infectious Diseases

109

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Hospitalizations for people who inject drugs (PWID) with infectious complications requiring prolonged antibiotic therapy are increasing in the context of the opioid epidemic. Although outpatient parenteral antimicrobial therapy (OPAT) is routinely offered to patients without a history of injection drug use (IDU), PWID are often excluded from consideration of OPAT. To better assess the evidence base for the safety and effectiveness of OPAT for PWID, we conducted a review of the published literature. Results suggest that OPAT may be safe and effective for PWID, with rates of OPAT completion, mortality, and catheter-related complications comparable to rates among patients without a history of IDU. Rates of hospital readmissions may be higher among PWID, but instances of misuse of the venous catheter were rarely reported. More research is needed to study the safety and effectiveness of OPAT among PWID, as well as studying the combination of OPAT and addiction treatment.

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Section: Discussionmentioning

confidence: 99%

Outpatient Parenteral Antimicrobial Therapy Among People Who Inject Drugs: A Review of the Literature

Suzuki

Johnson

Montgomery

et al. 2018

Open Forum Infectious Diseases

109

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“…15 However, clinicians' concerns regarding the misuse of a peripherally inserted central catheter to inject drugs in addition to treatment nonadherence, unstable living situations, and stigma associated with substance use have typically excluded people who inject drugs from receiving OPAT. 16,17 Despite these concerns, a 2018 systematic review 8 found that OPAT may be safe and beneficial for treating IDU-IE. To our knowledge, no study to date has compared the long-term impact and cost-effectiveness of OPAT with IV and partial oral antibiotic treatment strategies.…”

Section: Introductionmentioning

confidence: 99%

“…Another strategy, OPAT, is widely used to treat infections that require prolonged antibiotic therapy, and this treatment strategy has a proven safety record . However, clinicians’ concerns regarding the misuse of a peripherally inserted central catheter to inject drugs in addition to treatment nonadherence, unstable living situations, and stigma associated with substance use have typically excluded people who inject drugs from receiving OPAT . Despite these concerns, a 2018 systematic review found that OPAT may be safe and beneficial for treating IDU-IE.…”

Section: Introductionmentioning

confidence: 99%

Simulated Cost-effectiveness and Long-term Clinical Outcomes of Addiction Care and Antibiotic Therapy Strategies for Patients With Injection Drug Use–Associated Infective Endocarditis

et al. 2022

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IMPORTANCEEmerging evidence supports the use of outpatient parenteral antimicrobial therapy (OPAT) and, in many cases, partial oral antibiotic therapy for the treatment of injection drug use-associated infective endocarditis (IDU-IE); however, long-term outcomes and cost-effectiveness remain unknown. OBJECTIVE To compare the added value of inpatient addiction care services and the costeffectiveness and clinical outcomes of alternative antibiotic treatment strategies for patients with IDU-IE. DESIGN, SETTING, AND PARTICIPANTS This decision analytical modeling study used a validated microsimulation model to compare antibiotic treatment strategies for patients with IDU-IE. Model inputs were derived from clinical trials and observational cohort studies. The model included all patients with injection opioid drug use (N = 5 million) in the US who were eligible to receive OPAT either in the home or at a postacute care facility. Costs were annually discounted at 3%. Costeffectiveness was evaluated from a health care sector perspective over a lifetime starting in 2020. Probabilistic sensitivity, scenario, and threshold analyses were performed to address uncertainty. INTERVENTIONS The model simulated 4 treatment strategies: (1) 4 to 6 weeks of inpatient intravenous (IV) antibiotic therapy along with opioid detoxification (usual care strategy), (2) 4 to 6 weeks of inpatient IV antibiotic therapy along with inpatient addiction care services that offered medication for opioid use disorder (usual care/addiction care strategy), (3) 3 weeks of inpatient IV antibiotic therapy along with addiction care services followed by OPAT (OPAT strategy), and (4) 3 weeks of inpatient IV antibiotic therapy along with addiction care services followed by partial oral antibiotic therapy (partial oral antibiotic strategy). MAIN OUTCOMES AND MEASURES Mean percentage of patients completing treatment for IDU-IE, deaths associated with IDU-IE, life expectancy (measured in life-years [LYs]), mean cost per person, and incremental cost-effectiveness ratios (ICERs). RESULTSAll modeled scenarios were initialized with 5 million individuals (mean age, 42 years; range, 18-64 years; 70% male) who had a history of injection opioid drug use. The usual care strategy resulted in 18.63 LYs at a cost of $416 570 per person, with 77.6% of hospitalized patients completing treatment. Life expectancy was extended by each alternative strategy. The partial oral antibiotic strategy yielded the highest treatment completion rate (80.3%) compared with the OPAT strategy (78.8%) and the usual care/addiction care strategy (77.6%). The OPAT strategy was the least expensive at $412 150 per person. Compared with the OPAT strategy, the partial oral antibiotic (continued) Key Points Question What is the most clinically beneficial and cost-effective antibiotic treatment strategy for injection drug use-associated infective endocarditis (IDU-IE)? Findings In this decision analytical modeling study simulating 4 treatment strategies among 5 million individuals with IDU-IE in the US, a va...

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Leadership Roles in Opioid Stewardship and the Treatment of Patients with Opioid Use Disorder Among Medical Toxicologists

et al. 2019

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Injection Drug Use and Infectious Disease Practice: A National Provider Survey

Cited by 4 publications

References 0 publications

Outpatient Parenteral Antimicrobial Therapy Among People Who Inject Drugs: A Review of the Literature

Outpatient Parenteral Antimicrobial Therapy Among People Who Inject Drugs: A Review of the Literature

Simulated Cost-effectiveness and Long-term Clinical Outcomes of Addiction Care and Antibiotic Therapy Strategies for Patients With Injection Drug Use–Associated Infective Endocarditis

Leadership Roles in Opioid Stewardship and the Treatment of Patients with Opioid Use Disorder Among Medical Toxicologists

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