Lewis Sophia, Liang Stephen Y, Schwarz Evan S, Liss David B, Winograd Rachel P, Nolan Nathanial S, Durkin Michael J, Marks Laura R
Division of Infectious Diseases, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA.
Department of Emergency Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA.
Open Forum Infect Dis. 2022 Jan 6;9(2):ofab633. doi: 10.1093/ofid/ofab633. eCollection 2022 Feb.
Persons who inject drugs (PWID) are frequently admitted for serious injection-related infections (SIRIs). Outcomes and adherence to oral antibiotics for PWID with patient-directed discharge (PDD) remain understudied.
We conducted a prospective multicenter bundled quality improvement project of PWID with SIRI at 3 hospitals in Missouri. All PWID with SIRI were offered multidisciplinary care while inpatient, including the option of addiction medicine consultation and medications for opioid use disorder (MOUD). All patients were offered oral antibiotics in the event of a PDD either at discharge or immediately after discharge through an infectious diseases telemedicine clinic. Additional support services included health coaches, a therapist, a case manager, free clinic follow-up, and medications in an outpatient bridge program. Patient demographics, comorbidities, 90-day readmissions, and substance use disorder clinic follow-up were compared between PWID with PDD on oral antibiotics and those who completed intravenous (IV) antibiotics using an as-treated approach.
Of 166 PWID with SIRI, 61 completed IV antibiotics inpatient (37%), while 105 had a PDD on oral antibiotics (63%). There was no significant difference in 90-day readmission rates between groups ( = .819). For PWID with a PDD on oral antibiotics, 7.6% had documented nonadherence to antibiotics, 67% had documented adherence, and 23% were lost to follow-up. Factors protective against readmission included antibiotic and MOUD adherence, engagement with support team, and clinic follow-up.
PWID with SIRI who experience a PDD should be provided with oral antibiotics. Multidisciplinary outpatient support services are needed for PWID with PDD on oral antibiotics.
注射吸毒者（PWID）经常因严重的注射相关感染（SIRI）而入院。对于采用患者导向出院（PDD）的PWID患者，口服抗生素的治疗效果及依从性仍未得到充分研究。
我们在密苏里州的3家医院开展了一项针对患有SIRI的PWID的前瞻性多中心捆绑式质量改进项目。所有患有SIRI的PWID在住院期间都接受了多学科护理，包括成瘾医学咨询和阿片类药物使用障碍（MOUD）药物治疗的选择。所有患者在出院时或出院后立即通过传染病远程医疗诊所接受PDD时，均提供口服抗生素。额外的支持服务包括健康教练、治疗师、个案管理员、免费诊所随访以及门诊过渡项目中的药物治疗。采用治疗方式比较了接受口服抗生素PDD的PWID和完成静脉注射（IV）抗生素治疗的PWID的患者人口统计学特征、合并症、90天再入院率以及物质使用障碍诊所随访情况。
在166例患有SIRI的PWID中，61例在住院期间完成了静脉注射抗生素治疗（37%），而105例接受了口服抗生素的PDD（63%）。两组之间的90天再入院率无显著差异（P = 0.819）。对于接受口服抗生素PDD的PWID，7.6%有记录显示未坚持服用抗生素，67%有记录显示坚持服用，23%失访。预防再入院的因素包括抗生素和MOUD的依从性、与支持团队的参与度以及诊所随访。
经历PDD的患有SIRI的PWID应接受口服抗生素治疗。接受口服抗生素PDD的PWID需要多学科门诊支持服务。
