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

Abstract

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.

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

“…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].…”

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

“…However, the studies tended to have small sample sizes and did not evaluate new BSIs as a complication. 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.…”

Right-Sided Infective Endocarditis Secondary to Intravenous Drug Abuse

“…Due to reluctance of IVDA for prolonged hospital admission and the concerns related to their discharge on intravenous antibiotic therapy, a few studies have studied the possibility of treating IE in these patients with short course antibiotic therapy [23].…”