1027. Outpatient Parenteral Antimicrobial Therapy (OPAT) in Injection Drug Users (IDUs): Is It Safe?
Session: Poster Abstract Session: Bacteremia and Endocarditis
Friday, October 5, 2018
Room: S Poster Hall
Posters
  • OPAT Poster_ID Week_Final.pdf (538.3 kB)
  • Background:

    OPAT is widely implemented in the US. However, there are concerns surrounding discharge of IDU with a peripherally inserted central catheter (PICC). The objective of this study is to evaluate the characteristics and treatment outcomes of IDUs discharged on OPAT.

    Methods:

    This is a retrospective observational study conducted on patients (pts) discharged from an Infectious Diseases unit at a quaternary academic healthcare center in Detroit. Charts of all IDUs discharged on OPAT between 2011 and 2017 were reviewed. Current or former IDU were discharged on OPAT if they met the following criteria: self-reported history of IDU, stable living conditions, controlled psychiatric illness (if present) and willingness to sign a discharge agreement to refrain from using the PICC as a route for illicit drugs. Pts were categorized based on clinic follow-up (f/u) vs no clinic f/u. Outcomes evaluated were: cured (completed treatment and symptom free for 1 month after completion), improved (symptoms were improved but there was no confirmation of treatment completion); and relapsed (readmitted within 30 days for the same infection or sequela). Outcomes of pts with no clinic f/u were based on chart review of subsequent emergency department visits or admissions.

    Results:

    Pt characteristics are shown in Table 1. Of the 61 pts evaluated, 33 (54.1%) attended clinic f/u and 28 (45.9%) did not. Outcomes based on clinic f/u are shown in Table 2. Of the 18 patients who were cured, 16 attended clinic f/u vs 2 who did not.

    Conclusion:

    This study demonstrates that some IDUs can be discharged safely on OPAT. Pts with clinic follow-up had improved outcomes compared to those who did not. Further studies are needed to look at other predictors of outcome in this patient population.

    Table 1: Patient characteristics

    Patients

    N= 61 (%)

    Age (Mean ± SD)

    ±12.4

    Male

    33 (54.1)

    Length of stay (days)

    mean ± SD

    ± 10.9

    IVDU status

    Active

    Former

    Unknown

    49 (80.3)

    10 (16.4)

    2 (3.3)

    Psychiatric illness

    12 (19.7)

    Disposition

    Home

    Nursing facility

    37 (60.6)

    24 (39.3)

    Table 2. Outcome based on clinic follow-up

    Clinic f/u

    N = 33 (%)

    No clinic f/u

    N = 12 (%)

    P value

    Cured

    16 (48.5)

    2 (16.7)

    0.086

    Improved

    14 (42.4)

    6 (50)

    0.74

    Relapsed

    3 (9)

    4 (33.3)

    0.069

    *16 pts were excluded from the analysis because their outcome was unknown.

    Hira Rizvi, MD1, Nathalie Baratz, MD2, Hind Hadid, MD3, Ana C. Bardossy, MD4, Erica Herc, MD3, Helina Misikir, MPH5, Anne Chen, MD6, Norman Markowitz, MD1 and Marcus J Zervos, MD3, (1)Henry Ford Health System, Detroit, MI, (2)Infectious Disease, Henry Ford Health System, Detriot, MI, (3)Infectious Disease, Henry Ford Health System, Detroit, MI, (4)Division of Infectious Disease, Henry Ford Health System, Detroit, MI, (5)Henry Ford Hospital, Detroit, MI, (6)Henry Ford Hospital/Wayne State University School of Medicine, Detroit, MI

    Disclosures:

    H. Rizvi, None

    N. Baratz, None

    H. Hadid, None

    A. C. Bardossy, None

    E. Herc, None

    H. Misikir, None

    A. Chen, None

    N. Markowitz, None

    M. J. Zervos, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.