Oral Antibiotics Decrease Readmissions Among People Who Inject Drugs Admitted With Invasive Infections Leaving Against Medical Advice

People who inject drugs (PWID) are at risk for serious infectious complications requiring hospitalization for prolonged intravenous (IV) antibiotics. Individuals with substance use disorder (SUD) are at increased risk for leaving the hospital against medical advice (AMA) due to poorly treated withdrawal symptoms, lack of initiation of treatment for SUD, or other factors—which may pose challenges to antibiotic completion. This retrospective, observational, single-site study assessed 90-day readmission rates among 293 PWID hospitalized with serious infections related to injection drug use. All participants received an infectious disease consultation and, based on clinical care decisions and patients choice to leave AMA, 1 of 3 antibiotic treatment strategies: 1) Full course of IV antibiotics in-hospital; 2) partial course of IV antibiotics without a prescription for oral antibiotics at discharge; or 3) partial course of IV antibiotics with a prescription for oral antibiotics at discharge.

• 90-day all-cause readmission rates were highest among patients leaving AMA without a prescription for oral antibiotics (68%) compared with those receiving IV antibiotic treatment (32%) and those receiving partial oral antibiotic treatment (33%).
• Risk of 90-day readmission was highest among patients who did not receive oral antibiotic treatment at discharge (adjusted hazard ratio [aHR], 2.32), and not different among PWID who received oral antibiotic therapy at discharge (aHR, 0.99).
• Surgical source control (aHR, 0.57) and addiction medicine consultation (aHR, 0.57) were both associated with reduced 90-day readmission rates.

Comments: Although this was an observational study from a single site and only included patients who were seen by infectious disease teams, these data add to a growing literature suggesting the need for improvements for treatment of PWID who are hospitalized with serious infectious complications. Patients who choose not to remain inpatient should be given a prescription for oral antibiotics to complete the course of treatment.

Jeanette M. Tetrault, MD

Reference: Marks LR, Liang SY, Muthulingam D, et al. Evaluation of partial oral antibiotic treatment for persons who inject drugs and are hospitalized with invasive infections. Clin Infect Dis. 2020;ciaa365. doi: 10.1093/cid/ciaa365.