National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Sydney, Australia.
UCL Collaborative Centre for Inclusion Health, Institute of Epidemiology and Health Care, University College London, London, United Kingdom.
PLoS Med. 2022 Jul 19;19(7):e1004049. doi: 10.1371/journal.pmed.1004049. eCollection 2022 Jul.
Injecting-related bacterial and fungal infections are associated with significant morbidity and mortality among people who inject drugs (PWID), and they are increasing in incidence. Following hospitalization with an injecting-related infection, use of opioid agonist treatment (OAT; methadone or buprenorphine) may be associated with reduced risk of death or rehospitalization with an injecting-related infection.
Data came from the Opioid Agonist Treatment Safety (OATS) study, an administrative linkage cohort including all people in New South Wales, Australia, who accessed OAT between July 1, 2001 and June 28, 2018. Included participants survived a hospitalization with injecting-related infections (i.e., skin and soft-tissue infection, sepsis/bacteremia, endocarditis, osteomyelitis, septic arthritis, or epidural/brain abscess). Outcomes were all-cause death and rehospitalization for injecting-related infections. OAT exposure was classified as time varying by days on or off treatment, following hospital discharge. We used separate Cox proportional hazards models to assess associations between each outcome and OAT exposure. The study included 8,943 participants (mean age 39 years, standard deviation [SD] 11 years; 34% women). The most common infections during participants' index hospitalizations were skin and soft tissue (7,021; 79%), sepsis/bacteremia (1,207; 14%), and endocarditis (431; 5%). During median 6.56 years follow-up, 1,481 (17%) participants died; use of OAT was associated with lower hazard of death (adjusted hazard ratio [aHR] 0.63, 95% confidence interval [CI] 0.57 to 0.70). During median 3.41 years follow-up, 3,653 (41%) were rehospitalized for injecting-related infections; use of OAT was associated with lower hazard of these rehospitalizations (aHR 0.89, 95% CI 0.84 to 0.96). Study limitations include the use of routinely collected administrative data, which lacks information on other risk factors for injecting-related infections including injecting practices, injection stimulant use, housing status, and access to harm reduction services (e.g., needle exchange and supervised injecting sites); we also lacked information on OAT medication dosages.
Following hospitalizations with injection drug use-associated bacterial and fungal infections, use of OAT is associated with lower risks of death and recurrent injecting-related infections among people with opioid use disorder.
在注射吸毒者（PWID）中，与注射相关的细菌和真菌感染与显著的发病率和死亡率相关，而且其发病率正在上升。在因与注射相关的感染住院治疗后，使用阿片类激动剂治疗（OAT；美沙酮或丁丙诺啡）可能与降低与注射相关的感染再住院或死亡的风险有关。
数据来自阿片类激动剂治疗安全性（OATS）研究，这是一个包括澳大利亚新南威尔士州所有接受 OAT 治疗的人的行政关联队列，时间为 2001 年 7 月 1 日至 2018 年 6 月 28 日。纳入的参与者在因与注射相关的感染（即皮肤和软组织感染、败血症/菌血症、心内膜炎、骨髓炎、化脓性关节炎或硬膜外/脑脓肿）住院治疗后存活下来。结局是全因死亡和与注射相关的感染再住院。OAT 暴露通过住院后治疗天数的变化进行分类。我们使用单独的 Cox 比例风险模型评估每个结局与 OAT 暴露之间的关联。该研究包括 8943 名参与者（平均年龄 39 岁，标准差 [SD] 11 岁；34%为女性）。参与者指数住院期间最常见的感染是皮肤和软组织（7021 例；79%）、败血症/菌血症（1207 例；14%）和心内膜炎（431 例；5%）。在中位 6.56 年的随访期间，1481 名（17%）参与者死亡；使用 OAT 与较低的死亡风险相关（调整后的危险比[aHR]0.63，95%置信区间[CI]0.57 至 0.70）。在中位 3.41 年的随访期间，3653 名（41%）因与注射相关的感染再次住院；使用 OAT 与这些再住院的风险较低相关（aHR 0.89，95%CI 0.84 至 0.96）。研究的局限性包括使用常规收集的行政数据，这些数据缺乏与注射相关感染其他风险因素的信息，包括注射行为、注射兴奋剂使用、住房状况和获得减少伤害服务（如针具交换和监督注射点）；我们还缺乏 OAT 药物剂量的信息。
在因注射吸毒相关的细菌和真菌感染住院治疗后，使用 OAT 与患有阿片类药物使用障碍的患者的死亡风险和复发性与注射相关的感染风险降低相关。
