Suboptimal Management of Patients Hospitalized for Injection Drug Use-Related Infections

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Patient charts were included if injection drug use and any associated infection were documented in clinical notes.
Patient charts were included if injection drug use and any associated infection were documented in clinical notes.

Patients admitted to the hospital with an infection related to injection drug use (IDU) were found to rarely be prescribed medication-assisted treatment, but instead received screening, a brief intervention and referral to treatment (SBIRT), according the results of a retrospective chart review published in the Journal of Addiction Medicine.

The charts of patients admitted to UKHealthCare, an academic medical center in Lexington, Kentucky, for an injection drug use-related infection and requiring a lengthy regimen of intravenous antibiotics identified in individuals with “complex barriers to discharge,” were reviewed. Patient charts were included if injection drug use and any associated infection (eg, endocarditis, osteomyelitis, bacteremia, abscess, or cellulitis) were documented in clinical notes (n=108). Infections frequently associated with IDU in this cohort included endocarditis (60.2%) and osteomyelitis (25.0%). 

Primary care teams were found to document substance use more frequently at the time of hospitalization compared with discharge (95.4% vs 77.8%, respectively). More than half of the cohort (57.4%) had documentation of opioid use disorder as defined by the International Classification of Diseases, Ninth Revision. In 91.7% of episodes, patients were first referred to SBIRT vs pharmacotherapy intervention. Substance use cessation and medication-assisted treatment were recommended in 13% and 24.1% of patients, respectively. Patients were also prescribed opioids and benzodiazepines 48 hours before discharge (82.4% and 22.2%, respectively).

Limitations of the review include the retrospective nature of the analysis and the small number of charts, which were obtained from a single center.

 “It is imperative that providers emphasize directly addressing the diagnosis and treatment of [substance use disorder] when these patients are in contact with the healthcare system,” the researchers wrote. “A more comprehensive management approach integrating pharmacotherapy for [opioid use disorder] as well as harm reduction programs could have a substantial and potentially life-saving impact for [persons who inject drugs].”

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Reference

Jicha C, Saxon D, Lofwall MR, and Fanucchi LC. Substance use disorder assessment, diagnosis, and management for patients hospitalized with severe infections due to injection drug use [published online September 24, 2018]. J Addict Med. doi:10.1097/ADM.0000000000000454

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