1334. Outcomes of Outpatient Antibiotic Treatment of Injection Drug Users Discharged to Home with Central Venous Access.
Session: Poster Abstract Session: Clinical Practice Issues
Friday, October 28, 2016
Room: Poster Hall
Posters
  • IDSA Poster HTD.pdf (930.1 kB)
  • Background: Opioid addiction in the United States poses a significant public health risk. Persons who inject drugs (PWID) suffer from high mortality and morbidity secondary to serious infections, some of which require prolonged courses of parenteral antibiotics. The safety and outcomes of outpatient parenteral antibiotic therapy (OPAT) in PWID is unknown. Our goal was to study the outcomes of PWIDs treated with intravenous antibiotics via central venous access at home.

    Methods: The study population was identified via patient research databases. The population included patients with known injection drug use (IDU) within 2 years of admission who were discharged directly to home and expected to receive at least two weeks of OPAT after discharge. Retrospective chart review was used to study the outcomes related to infection, IV catheter complications, and addiction.

    Results: We identified 10 patients who met our study criteria. All patients had plans in place for drug use monitoring or substance use treatment, and had received significant counseling prior to discharge regarding OPAT risks. Out of the 10 patients, 9 had used opioids and 1 had used cocaine within 2 years of admission. 7 were treated for endocarditis, 1 for a deep hardware infection, 1 for a septic joint, and 1 for osteomyelitis. One patient had a non-IDU related cardiac death following discharge. Only one patient had a line complication; this patient reused injection drugs and developed line infection. The patient was readmitted, the line was removed and he was transitioned to oral therapy. The remaining patients were able to complete their planned OPAT courses without line infections or thrombosis, re-admission, relapse of drug use, loss to follow-up, or change in the OPAT course. All had clinical infection cure.

    Conclusion: Our descriptive study suggests that home discharge of PWID requiring OPAT can be a safe option for carefully selected patients also receiving addictions care. All but one of the patients reviewed were able to safely complete OPAT at home. This can be a viable treatment option for select patients with appropriate support that would allow these high-risk and vulnerable patients to receive optimal therapy.

    Helen D'couto, BS1,2, Gregory Robbins, MD, MPH, FIDSA3, Kevin Ard, MD2, Sarah Wakeman, MD4,5, Justin Alves, RN1 and Sandra Nelson, MD, FIDSA2,6, (1)Massachusetts General Hospital, Boston, MA, (2)Harvard Medical School, Boston, MA, (3)Infectious Disease, Massachusetts General Hospital, Boston, MA, (4)Medicine, Massachusetts General Hospital, Boston, MA, (5)Medicine, Harvard Medical School, Boston, MA, (6)Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA

    Disclosures:

    H. D'couto, None

    G. Robbins, Pfizer: Investigator , Research support

    K. Ard, None

    S. Wakeman, None

    J. Alves, None

    S. Nelson, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.