Support system helps outpatients adhere to antibiotics for injection-related infections
Click Here to Manage Email Alerts
Patients with serious injection-related infections who are discharged on oral antibiotic regimens can be adherent to the medicine but need “substantial” outpatient support, researchers found.
“Our area was seeing an increasing number of patients admitted with severe infectious complications from injection drug use,” Laura Marks, MD, PhD, an infectious diseases physician and instructor in medicine at the Washington University in St. Louis School of Medicine, told Healio.
“There is strong evidence from a number of recent studies which have demonstrated that [people who inject drugs (PWID)] with serious injection drug use-related infections have higher antibiotic completion rates and lower readmission rates when they are offered treatment for the underlying substance use disorder,” Marks explained. “However, even once the underlying substance use disorder is addressed, many patients may still face challenges in completing 6 weeks of IV antibiotics.”
For their study, Marks and colleagues implemented a prospective multicenter bundled quality improvement project for PWID with serious injection-related infections (SIRIs) and patient-directed discharge (PDD) at three hospitals in Missouri.
They offered all enrolled PWID with SIRI multidisciplinary care while under inpatient care, including the option of addiction medicine consultation and medications for opioid use disorder (MOUD). They also offered them oral antibiotics in the event of a PDD at discharge or immediately after discharge through an infectious disease telemedicine clinic.
The researchers compared the outcomes of PWID who were discharged on oral antibiotics (n = 155) with patients who completed IV antibiotics (61) and found no significant difference in 90-day readmission rates between the two groups (P = .819).
Among PWID in the oral antibiotics arm, 7.6% had documented nonadherence to antibiotics, 67% had documented adherence and 23% were lost to follow-up. The researchers found that patient factors that were protective against readmission included antibiotic and MOUD adherence, engagement with a support team, and clinic follow-up.
“All patients who cannot complete 6 weeks of IV antibiotics for serious injection-related infections such as endocarditis, epidural abscesses, septic arthritis or osteomyelitis should be offered an alternative antibiotic plan such as long-acting lipoglycopeptides or oral antibiotics,” Marks said. “Outpatient support including peer recovery coaches and case management is crucial to helping PWID successfully complete prolonged oral antibiotic regimens for serious injection drug use-related infections.”
Collapse
Read more about
Click Here to Manage Email Alerts