Low Use of Outpatient Parenteral Antimicrobial Therapy for Drug Use-Associated Infective Endocarditis in an Urban Hospital System
Open Access
- 1 March 2021
- journal article
- research article
- Published by Oxford University Press (OUP) in Open Forum Infectious Diseases
- Vol. 8 (3), ofab083
- https://doi.org/10.1093/ofid/ofab083
Abstract
Background. The opioid crisis in the United States has led to increasing hospitalizations for drug use-associated infective endocarditis (DUA-IE). Outpatient parenteral antimicrobial therapy (OPAT), the preferred modality for intravenous antibiotics for infective endocarditis, has demonstrated similar outcomes among patients with DUA-IE versus non-DUA-IE, but current studies suffer selection bias. The utilization of OPAT for DUA-IE more generally is not well studied. Methods. This retrospective cohort study compared OPAT use for DUA-IE versus non-DUA-IE in adults hospitalized between January 1, 2015 and September 1, 2019 at 3 urban hospitals. We used multivariable regression analysis to assess the association between DUA-IE and discharge with OPAT, adjusting for clinically significant covariables. Results. The cohort included 518 patients (126 DUA-IE, 392 non-DUA-IE). Compared to those with non-DUA-IE, DUA-IE patients were younger (53.0 vs 68.2 years, P < .001) and more commonly undomiciled (9.5% vs 0.3%, P < .01). Patients with DUA-IE had a significantly lower odds of discharge with OPAT than non-DUA-IE patients (adjusted odds ratio [aOR] = 0.20; 95% confidence interval [CI], 0.10-0.39). Odds of discharge with OPAT remained lower for patients with DUA-IE after excluding undomiciled patients (aOR = 0.22; 95% CI, 0.11-0.43) and those with patient-directed discharges (aOR = 0.27; 95% CI, 0.14-0.52). Conclusions. Significantly fewer patients with DUA-IE were discharged with OPAT compared to those with non-DUA-IE, and undomiciled patients or patient-directed discharges did not fully account for this difference. Efforts to increase OPAT utilization among patients with DUA-IE could have important benefits for patients and the healthcare system. Keywords. endocarditis; OPAT; opioid use disorder; substance use disorder.Funding Information
- National Institutes for Health National Center for Advancing Translational Science Einstein-Montefiore CTSA (UL1 TR002556)
- National Institute of Mental Health (K23MH106386)
- Einstein-Rockefeller-CUNY Center for AIDS Research (P30AI124414)
This publication has 39 references indexed in Scilit:
- Leaving the Hospital Against Medical Advice Among People Who Use Illicit Drugs: A Systematic ReviewAmerican Journal of Public Health, 2015
- Length of stay an important mediator of hospital-acquired methicillin-resistant Staphylococcus aureusEpidemiology and Infection, 2015
- Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of ComplicationsCirculation, 2015
- Outcomes from global adult outpatient parenteral antimicrobial therapy programmes: A review of the last decadeInternational Journal of Antimicrobial Agents, 2014
- Increased Risk of Mortality and Readmission among Patients Discharged Against Medical AdviceThe American Journal of Medicine, 2012
- Safe and successful treatment of intravenous drug users with a peripherally inserted central catheter in an outpatient parenteral antibiotic treatment serviceJournal of Antimicrobial Chemotherapy, 2010
- Clinical efficacy and cost-effectiveness of outpatient parenteral antibiotic therapy (OPAT): a UK perspectiveJournal of Antimicrobial Chemotherapy, 2009
- The Underrecognized Epidemic of Low Mobility During Hospitalization of Older AdultsJournal of the American Geriatrics Society, 2009
- Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics supportJournal of Biomedical Informatics, 2008
- A new method of classifying prognostic comorbidity in longitudinal studies: Development and validationJournal of Chronic Diseases, 1987