Rogers Daniel J, Zhao Lingyu, Zhan Duna, Chen Xianyan, Krsak Martin, Henao-Martínez Andrés F, Chastain Daniel B
Department of Pharmacy, Emory Healthcare, Atlanta, Georgia, USA.
School of Economics and Management, University of Science and Technology Beijing, Beijing, China.
Open Forum Infect Dis. 2025 Jun 2;12(6):ofaf315. doi: 10.1093/ofid/ofaf315. eCollection 2025 Jun.
Outpatient parenteral antimicrobial therapy (OPAT) is often withheld from individuals with substance use disorder (SUD), despite evidence suggesting similar outcomes. We investigated this using a large, nationwide claims database.
We analyzed Merative MarketScan (2015-2020) data to identify adults treated with intravenous vancomycin, daptomycin, nafcillin, oxacillin, or cefazolin for ≥7 days after hospitalization. Patients with end-stage renal disease or were excluded. SUD was defined using pre-discharge International Classification of Diseases 10-CM codes. Rates of overdose, central venous catheter (CVC) events during OPAT, and 90-day all-cause readmissions following OPAT completion were compared between patients with and without SUD, adjusting for confounders via multivariable logistic regression.
Among 5903 patients, 18% had SUD. These patients were younger, less often male, and less likely discharged home. Unadjusted rates of 90-day readmission (40.1% vs 32.5%, < .001) and overdose (1.2% vs 0.1%, < .001) were higher in the SUD group, whereas CVC event rates were similar (6.5% vs 5.3%, = .137). However, adjusted analyses revealed SUD was not significantly associated with readmission (odds ratio [OR] 1.16, = .067) or CVC events (OR 1.10, = .552), but was associated with higher odds of overdose (OR 6.03, < .001). Readmission was predicted by insurance type, mental health disorders, and infection type. CVC events were associated with infection type and discharge to home.
SUD was not independently associated with increased 90-day readmission or CVC event risk, but was a significant risk factor for overdose, supporting harm reduction approaches over exclusion from OPAT based on SUD status.
尽管有证据表明结果相似，但患有物质使用障碍（SUD）的个体通常无法接受门诊胃肠外抗菌治疗（OPAT）。我们使用一个大型的全国性索赔数据库对此进行了调查。
我们分析了Merative MarketScan（2015 - 2020年）的数据，以识别住院后接受静脉注射万古霉素、达托霉素、萘夫西林、苯唑西林或头孢唑林治疗≥7天的成年人。排除终末期肾病患者。使用出院前国际疾病分类第10版临床修正码定义SUD。比较有无SUD患者的药物过量率、OPAT期间中心静脉导管（CVC）事件发生率以及OPAT完成后90天全因再入院率，并通过多变量逻辑回归调整混杂因素。
在5903名患者中，18%患有SUD。这些患者更年轻，男性比例更低，出院回家的可能性更小。SUD组未调整的90天再入院率（40.1%对32.5%；P <.001）和药物过量率（1.2%对0.1%；P <.001）更高，而CVC事件发生率相似（6.5%对5.3%；P =.137）。然而调整分析显示，SUD与再入院（比值比[OR]1.16；P =.067）或CVC事件（OR1.10；P =.552）无显著关联，但与更高的药物过量几率相关（OR6.03；P <.001）。再入院可通过保险类型、精神健康障碍和感染类型预测。CVC事件与感染类型和出院回家有关。
SUD与90天再入院风险增加或CVC事件风险无独立关联，但却是药物过量的重要危险因素，这支持了基于减少伤害的方法，而非基于SUD状态将患者排除在OPAT之外。
