WVU Medicine, Department of Pharmacy, Morgantown, WV, USA.
WVU Clinical and Translational Science Institute, Morgantown, WV, USA.
J Pharm Pharm Sci. 2022;25:266-273. doi: 10.18433/jpps32891.
Intravenous drug use (IVDU) is an independent risk factor for infective endocarditis (IE). IVDU-related IE is associated with poor clinical outcomes, such as infection-related and drug abuse-related readmissions and mortality. Critical interventions to treat addiction, such as medication for opioid use disorder (MOUD) with buprenorphine, may prevent these unfavorable outcomes. This study aimed to establish the effectiveness of buprenorphine prescriptions at hospital discharge for patients admitted for IVDU-related IE.
A single center, retrospective cohort study evaluated the effectiveness of discharge prescriptions of buprenorphine in adult patients (≥18 years of age) with OUD and IVDU-related IE. Outcomes of 30-day readmissions, 180-day readmissions, and mortality were compared to a cohort of patients who were not prescribed buprenorphine at hospital discharge.
The primary endpoint of all cause 30-day readmission was lower in patients who received buprenorphine (n=11/122, 9%) at hospital discharge for IVDU-related IE compared to those who did not (n=9/48, 19%), although not statistically significant (unadjusted OR 0.429, 95% CI 0.165-1.138, p=0.082). After accounting for intensive care admission, infusion unit admission, and psychiatry consultation, the odds of all cause 30-day readmission were statistically lower in patients prescribed buprenorphine (adjusted OR 0.337, 95% CI 0.125-0.909, p=0.029). Additionally, significantly more patients prescribed buprenorphine at discharge followed-up in an outpatient treatment program, 57% and 15% respectively (p<0.001). Incidence of readmission at 180 days and mortality was similar between the two cohorts.
This study demonstrated that buprenorphine prescriptions at hospital discharge in patients with OUD admitted for IVDU-related IE were effective at decreasing readmission rates at 30 days and increasing outpatient treatment follow-up. Therefore, it is imperative that an emphasis on addiction-focused interventions, such as initiating buprenorphine, be considered in this patient population at hospital discharge to decrease hospital readmissions and engage patients in outpatient treatment for OUD. This study is the first to evaluate the effects of MOUD on readmission rates for patients hospitalized with IVDU-related IE and contributes to the growing body of evidence to support addiction-focused interventions for this unique patient population.
静脉药物滥用（IVDU）是感染性心内膜炎（IE）的独立危险因素。与静脉药物滥用相关的 IE 与不良临床结局相关，例如感染相关和药物滥用相关的再入院和死亡率。治疗成瘾的关键干预措施，如使用丁丙诺啡的阿片类药物使用障碍（MOUD）药物，可能预防这些不良结局。本研究旨在确定 IVDU 相关 IE 患者出院时开具丁丙诺啡处方的效果。
一项单中心回顾性队列研究评估了 IVDU 相关 IE 合并 OUD 成人患者出院时开具丁丙诺啡处方的效果。比较了接受丁丙诺啡（n=11/122，9%）与未接受丁丙诺啡（n=9/48，19%）出院的患者 30 天和 180 天再入院率和死亡率。
尽管没有统计学意义（未调整的 OR 0.429，95%CI 0.165-1.138，p=0.082），但与未接受丁丙诺啡的患者相比，接受丁丙诺啡的患者（n=11/122，9%）出院时发生任何原因 30 天再入院的主要终点较低。在考虑重症监护病房入院、输液单元入院和精神病学咨询后，接受丁丙诺啡治疗的患者任何原因 30 天再入院的可能性在统计学上较低（调整后的 OR 0.337，95%CI 0.125-0.909，p=0.029）。此外，分别有 57%和 15%的出院时开具丁丙诺啡的患者在出院后分别接受了门诊治疗方案，差异有统计学意义（p<0.001）。两组患者在 180 天内的再入院率和死亡率相似。
本研究表明，在因 IVDU 相关 IE 住院的 OUD 患者中，出院时开具丁丙诺啡可有效降低 30 天再入院率，并增加门诊治疗随访。因此，在该患者人群中，出院时应强调以成瘾为重点的干预措施，如开始丁丙诺啡治疗，以降低医院再入院率，并使患者接受 OUD 的门诊治疗。本研究首次评估了 MOUD 对因 IVDU 相关 IE 住院患者再入院率的影响，并为支持针对这一独特患者群体的以成瘾为重点的干预措施提供了更多证据。
