From the Division of Infectious Diseases, Department of Medicine, University of Nebraska Medical Center, Omaha, NE (NC-P, KC); Department of Pharmaceutical and Nutrition Care, Nebraska Medicine, Omaha, NE (BTA); Department of Psychiatry, University of Nebraska Medical Center, Omaha, NE (VMMK, AAB).
J Addict Med. 2022;16(4):392-395. doi: 10.1097/ADM.0000000000000936. Epub 2021 Oct 27.
Patients with injection drug use-associated infective endocarditis and opioid use disorder often receive treatment for the infection that fails to address its underlying cause. People who inject drugs (PWID) and develop serious infections also face disparities in antibiotic management, particularly with regards to use of outpatient parenteral antimicrobial therapy (OPAT). We highlight literature on OPAT in PWID challenging the notion that PWID cannot be managed with OPAT. Given that OPAT use amongst PWID and non-PWID yields similar outcomes, we argue that a bias against OPAT use in PWID is unwarranted and may reflect stigma rather than data. We further note the proven value of comprehensive OUD treatment on endocarditis treatment outcomes, which also addresses the potential safety concerns of OPAT in PWID, and propose a treatment model in which Addiction and Infectious Disease specialists collaborate to integrate opioid use disorder treatment into injection drug use-associated infective endocarditis care.
患有注射毒品相关感染性心内膜炎和阿片类药物使用障碍的患者经常接受治疗感染的治疗，而未能解决其根本原因。注射毒品的人 (PWID) 并发生严重感染的人也面临抗生素管理方面的差异，特别是在门诊肠外抗菌治疗 (OPAT) 的使用方面。我们强调了关于 PWID 中 OPAT 的文献，这些文献挑战了 PWID 不能使用 OPAT 进行治疗的观点。鉴于 PWID 和非 PWID 使用 OPAT 的结果相似，我们认为反对 PWID 使用 OPAT 的偏见是没有根据的，可能反映的是污名化，而不是数据。我们还注意到综合阿片类药物使用障碍治疗对心内膜炎治疗结果的证明价值，这也解决了 PWID 中 OPAT 的潜在安全问题，并提出了一种治疗模式，其中成瘾和传染病专家合作将阿片类药物使用障碍治疗纳入注射毒品相关感染性心内膜炎护理中。
