Cooper D Kane, Okumu Eunice A, McInnes Bailey, Ansary Maisun M, Esposito Maria, Merenbloom Carson, Ostrach Bayla, Chu Vivian H, Wu Li-Tzy, Golin Carol, Rosen David L, Schranz Asher J
J Addict Med. 2025 Jul 17. doi: 10.1097/ADM.0000000000001545.
Injection drug use is a leading and growing risk factor for infective endocarditis (IE), as evidenced by a marked national increase in hospitalizations for drug use-associated infective endocarditis (DUA-IE). The typical treatment approach for persons with DUA-IE is a 6-week inpatient course of intravenous antimicrobials. This approach is resource-intensive, requiring substantial hospital resources and lengthy stays. Alternative methods of antibiotic delivery for DUA-IE treatment have been proposed and piloted, but their acceptance among people who inject drugs is unknown.
Persons hospitalized with DUA-IE (N = 16) completed semi-structured interviews to identify facilitators and barriers to 3 proposed IE treatment options: (A) hospitalization for the entirety of antibiotic treatment, the current standard of care; (B) home-based outpatient parenteral antimicrobial therapy via indwelling catheter; or (C) weekly outpatient visits for long-acting antibiotic infusion. Interviews were transcribed and thematically coded to identify participant perspectives and preferences among these strategies.
Option A was ranked the most preferred treatment regimen (8 participants, 50%), followed by options C (5 participants, 31%) and B (3 participants, 19%). Participants felt option A provided the most effective treatment for their endocarditis, despite dissatisfaction with the hospitalization length. Options B and C appealed to participants given the convenience of outpatient care; however, inadequate transportation and housing instability were prominently cited as barriers.
These diverse patient perspectives should inform trials to evaluate the effectiveness of alternative antibiotic delivery strategies, as well as interventions to improve patient-centered decision-making for DUA-IE treatment.
注射吸毒是感染性心内膜炎（IE）的一个主要且不断增加的危险因素，与吸毒相关的感染性心内膜炎（DUA-IE）住院人数在全国范围内显著增加就证明了这一点。DUA-IE患者的典型治疗方法是进行为期6周的静脉抗菌药物住院治疗。这种方法资源消耗大，需要大量医院资源和长时间住院。已有人提出并试点了用于DUA-IE治疗的替代抗生素给药方法，但它们在注射吸毒者中的接受程度尚不清楚。
因DUA-IE住院的患者（N = 16）完成了半结构化访谈，以确定对3种提议的IE治疗方案的促进因素和障碍：（A）整个抗生素治疗期间住院，这是当前的护理标准；（B）通过留置导管进行家庭门诊胃肠外抗菌治疗；或（C）每周门诊进行长效抗生素输注。访谈内容被转录并进行主题编码，以确定参与者对这些策略的看法和偏好。
方案A被评为最受欢迎的治疗方案（8名参与者，50%），其次是方案C（5名参与者，31%）和方案B（3名参与者，19%）。尽管对住院时间不满意，但参与者认为方案A为他们的心内膜炎提供了最有效的治疗。方案B和C因门诊护理的便利性而吸引了参与者；然而，交通不便和住房不稳定被显著提及为障碍。
这些不同的患者观点应为评估替代抗生素给药策略有效性的试验以及改善DUA-IE治疗中以患者为中心的决策的干预措施提供参考。
