Issue: May 2020
Disclosures: Marks reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
April 20, 2020
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Oral antibiotic regimen for PWID with invasive infections reduces readmission rates

Issue: May 2020
Disclosures: Marks reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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Laura R. Marks

All-cause readmission rates at 90 days among people who inject drugs and left the hospital against medical advice decreased when they were prescribed oral antibiotic therapy — including partial IV therapy and partial oral therapy — compared with patients who were not prescribed any antibiotics, according to findings in Clinical Infectious Diseases.

In addition, people who inject drugs (PWID) who were treated with outpatient oral antibiotics — including partial IV therapy and partial oral therapy — experienced similar readmission rates compared with individuals who finished a course of inpatient IV antibiotic therapy.

“Our hospital, like many others around the United States, has seen a substantial increase in admissions for injection drug-related infections,” Laura R. Marks, MD, PhD, a fourth-year fellow in the division of infectious diseases at Washington University School of Medicine in St. Louis, told Healio. “While we have many rigorous guidelines on best practices for the treatment of any individual infection, many of those guidelines are difficult to implement for PWID in real-world settings.”

According to Marks, in many hospitals, PWID are not eligible for discharge on outpatient IV antibiotics. As a result, in order to receive standard of care treatment, they must remain in the hospital, often for 4 to 6 weeks or longer. For many patients, this is “incredibly challenging” and can result in an AMA discharge before the completion of antibiotic therapy.

“This study came from a desire by much of our team to understand what the best practice was in these situations,” Marks said.

Marks and colleagues performed a retrospective cohort study of 293 PWID aged 18 years and older who were admitted to a tertiary referral center and received an infectious disease consult for an invasive bacterial or fungal infection between January 2016 and July 2019.

Overall, 90-day all cause readmission rates were highest among PWID who were not treated with oral antibiotic therapy upon an AMA discharge (68.7%) compared with inpatient IV antibiotics and partial oral antibiotics (31.5% and 32.5%, respectively). A multivariate analysis demonstrated that 90-day readmission risk was higher among PWID who did not receive oral antibiotic therapy on AMA discharge (adjusted HR = 2.32; 95% CI, 1.41-3.82) and not different among PWID prescribed oral antibiotic therapy on AMA discharge (aHR = 0.99; 95% CI, 0.62-1.62).

Surgical source control (aHR = 0.57; 95% CI, 0.37-0.87) and addiction medicine consultation (aHR = 0.57; 95% CI, 0.38-0.86) also correlated with a decrease in readmissions.

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The results of this single-center study suggest that access to oral antibiotic therapy for PWID who are not able to finish a prolonged course of inpatient IV antibiotics is beneficial, according to the authors.

“Comprehensive care of PWID with injection-related infections should include integration of substance use disorder care and an early discussion about barriers to care, as well as a patient's ability to complete a standard-of-care inpatient IV antibiotic course,” Marks concluded. “For those patients who are unable to complete a prolonged IV antibiotic course, access to oral antibiotics paired with close ID clinic follow-up is beneficial.” – by Caitlyn Stulpin

Disclosures: Marks reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.