MANUBRIOSTERNAL JOINT SEPTIC ARTHRITIS IN A MAN WITH A HISTORY OF IV DRUG USE

Category: Infection Introduction/Purpose: Although intravenous drug use (IDU) is a known risk factor for septic arthritis of the foot and ankle (F&A), little is known about its influence on hospitalization outcomes. This study evaluated differences in demographic characteristics and hospitalization outcomes of septic arthritis of the F&A according to IDU status. Methods: Using the Nationwide Inpatient Sample for the years 2000 to 2013, we identified all patients aged 15-64 with a principal discharge diagnosis of septic arthritis of the F&A. Applying previously published algorithms, septic arthritis of the F&A was classified as related or unrelated to IDU. We assessed differences in demographic characteristics and in-hospital outcomes including length of hospital stay (LOS), leaving against medical advice (AMA), hospital charges, and presence or absence of surgical intervention. Results: Of the 14,198 hospitalizations, 11% were associated with IDU. Patients with IDU were more likely to be younger, black, and have Medicaid or no insurance coverage. Patients with IDU were more likely to leave AMA (9.7% vs 1.4%, p<0.001), have longer LOS (9.2 vs 6.8 days, p<0.001), and incur increased hospital charges ($58,628 vs $38,876, p=0.005). In addition, patients with IDU were significantly less likely to receive an arthroscopy (1.5% vs 6.5%, p<0.001) or arthrotomy (2.2% vs 11.0%, p<0.001) of the foot. Conclusion: IDU-related septic arthritis of the foot and ankle is associated with suboptimal hospitalization outcomes and greater resource use. Given the disparity in outcomes, there is potential to improve outcomes of septic arthritis of the foot and ankle in patients with IDU via enhanced physician communication skills among disenfranchised patient populations and proactively addressing substance abuse issues early during hospital admission.

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28. The Paradox of an Integrated MAT OPAT Program

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.230 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S137-S137

Author(s):

Paula Eckardt ◽

Jessica Reed ◽

Claudia P Vicencio ◽

Alberto Augsten

Keyword(s):

Drug Use ◽

Behavioral Health ◽

Healthcare System ◽

Standard Of Care ◽

Opioid Use Disorder ◽

Opioid Use ◽

History Of ◽

Picc Line ◽

Iv Drug Use ◽

To Receive

Abstract Background Patients with substance use disorders (SUD), specifically opioid use disorder (OUD) and injection drug use (IDU) utilize healthcare resources for prolonged inpatient treatment of serious infections stemming from their addictions. For a variety of reasons, physicians treating these patients refuse to send these patients home to receive outpatient parenteral antimicrobial therapy (OPAT), and instead keep the patient in the hospital for several weeks or longer to complete treatment for the injection-related infections. Patients who do not have history of IDU are sent home with a PICC line to receive OPAT once they are no longer acutely ill and therefore no longer meet criteria to remain inpatient, which is the established standard of care. Patients with OUD and IDU are not allowed the same standard of care, and furthermore do not receive adequate, if any, therapy for their primary problem and reason for their serious infection – the addiction. Flow chart of the MAT-OPAT process Methods Medication-assisted treatment (MAT) with buprenorphine-naloxone has been approved for treating adults with opioid use disorder as part of a comprehensive treatment program that also includes counseling and behavioral therapy. Until now in our healthcare system there has been no comprehensive and integrated program to safely discharge patients with OUD and IDU to receive OPAT via a PICC line, while simultaneously treating their addiction. We describe the implementation of a MAT-OPAT program. Please refer to the chart included. Results We present a successful case of a 36-year-old male with a history of endocarditis associated with IV drug use and the intervention of the Healthcare System to link the patient to appropriate Infectious disease, behavioral health and medication adherence treatment for opioid abuse. The patient completed the IV antibiotic therapy and remained enrolled in the behavioral health program with a successful outcome. Conclusion MAT-OPAT implementation in large healthcare system with continuous outpatient support that includes Infectious Disease services, behavioral health and drug abuse rehabilitation therapy can be a successful strategy to minimize readmisión, cost and complications in patients with history of IV drug use and infections that require prolonged intravenous antibiotic therapy. Disclosures All Authors: No reported disclosures

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764. Patients with Substance Use Disorder Discharged from Safety Net Hospital to Skilled Nursing Facility for OPAT: Baseline Characteristics and Clinical Outcomes

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.832 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S340-S340

Author(s):

Cylaina Bird ◽

Ryan Collins ◽

Norman Mang ◽

Ank E Nijhawan ◽

...

Keyword(s):

Substance Use ◽

Drug Use ◽

Clinical Outcomes ◽

Substance Use Disorder ◽

Safety Net ◽

Skilled Nursing ◽

Methamphetamine Use ◽

Polysubstance Use ◽

History Of ◽

Iv Drug Use

Abstract Background Self-administered Outpatient Parenteral Antimicrobial Therapy (S-OPAT) is offered at Parkland Memorial Hospital for uninsured patients requiring an extended course of intravenous (IV) antibiotics to complete treatment at home.1 At Parkland, S-OPAT has been demonstrated to be safe and effective with >70,000 inpatient bed days avoided to date, lower 30-day readmission rates, and significant cost savings.1 Patients with a history of substance use are not eligible for S-OPAT and are discharged to skilled nursing facilities (SNF) to complete IV antibiotic therapy. This study aims to describe clinical outcomes of a patient population with history of substance use discharged to SNF for OPAT. Methods The electronic medical record was used to identify patients with substance use discharged to an SNF for OPAT between January 1, 2017 and April 30, 2018. Data were retrospectively reviewed for demographics, substance use history, treatment plan and clinical outcomes. Results 76 patients with history of substance use were discharged to SNFs for OPAT in the study period. 62% of patients reported non-IV drug use and 38% reported IV drug use (IVDU). The mean age for patients with non-IV drug use was 47 (83% male) vs. 43 years for patients with IVDU (86% male). Of patients with non-IV drug use, 30% reported cocaine use, 11% methamphetamine use and 59% polysubstance use or other. Of patients with IVDU, 38% reported heroin use, 10% methamphetamine use and 52% polysubstance use or other. When comparing outcomes of IVDU vs. non-IV drug use patients, 34% vs. 21% did not complete the prescribed treatment course, 28% vs. 11% left against medical advice (AMA), and 20% vs. 15% were readmitted to the hospital within 30 days. Conclusion The majority of patients with substance use, 74%, completed their prescribed IV antibiotic course when sent to an SNF. However, a subset of these patients is at risk for poor clinical outcomes. A greater proportion of patients with prior IVDU compared with patients with prior non-IV drug use left treatment AMA and were readmitted to our hospital within 30 days of discharge. Future efforts to identify patients with substance use disorder who may be appropriate for S-OPAT with integration of addiction medicine services may improve clinical outcomes. Disclosures Ank E. Nijhawan, MD, MPH, Gilead Sciences, Inc.: Research Grant.

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1298. Analysis of Factors Influencing Consent for Opt-out HIV Screening Among High-Risk Groups Vulnerable to HIV in an Urban Emergency Department

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1161 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S468-S468

Author(s):

Anjana Maheswaran ◽

Abhinav K Reddy ◽

Mary Kate Mannion ◽

Janet Lin

Keyword(s):

Risk Factors ◽

Emergency Department ◽

High Risk ◽

Drug Use ◽

Hiv Screening ◽

Consent Rate ◽

Screening Programs ◽

Opt Out ◽

History Of ◽

Iv Drug Use

Abstract Background The University of Illinois Hospital Emergency Department (ED) implemented routine, electronic medical record (EMR)-driven opt-out HIV screening in November 2014. Programmatic data indicated an average consent rate of 79%, similar to other ED HIV screening programs in the country. However, there is limited evidence on the role risk factors play on consent rate. The objective of this study was to explore the relationship between patients’ risk factors for HIV and the likelihood of declining screening. Methods The ED screening algorithm has a nontargeted and targeted component qualifying individuals based on age and presence of risk factors, respectively. We retrospectively evaluated risk factors and consent responses of high-risk individuals identified by the targeted component of the EMR algorithm between January 2017 and March 2019. We performed a multivariate logistic regression analysis in R to explore the association between risk factors and the likelihood of declining screening. Results Of 47,197 screening eligible individuals, 27,044 were high-risk among whom 12% never consented. The majority of those who never consented had no history of intravenous (IV) drug use, homelessness, unsafe sexual practices, recent sexually transmitted infection (STI) and did not identify as homosexual, bisexual or transgender. Individuals who identified as homosexual, bisexual, or transgender (OR = 0.53), from high-risk zip code (OR = 0.77), with history of IV drug use (OR = 0.43), and with recent STI (OR = 0.60) were found to be significantly less likely to never consent compared with their counterparts. Also, patients who were male (OR = 1.14), White (OR = 1.38), Asian (OR = 1.57), Native Hawaiian or Pacific Islander, American Indian or Alaska Native (OR = 1.44) were significantly more likely to never consent compared with their counterparts. Conclusion Our results show that patients at high risk for HIV consent at higher rates for HIV screening in an opt-out setting. These findings suggest that while educational efforts on the importance of testing may have been successful in patients at the highest risk, additional efforts are needed to improve awareness among those who may not self-identify or be identified by medical providers as being at risk for HIV and reinforce the importance of universal screening. Disclosures All authors: No reported disclosures.

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Patients with infective endocarditis and history of injection drug use in a Swedish referral hospital during 10 years

BMC Infectious Diseases ◽

10.1186/s12879-021-05914-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Anna Damlin ◽

Katarina Westling

Keyword(s):

Infective Endocarditis ◽

Drug Use ◽

Injection Drug Use ◽

Clinical Characteristics ◽

National Registry ◽

Injection Drug ◽

University Hospital ◽

Prosthetic Heart Valves ◽

Increased Risk ◽

History Of

Abstract Background Patients with injection drug use (IDU) have increased risk of developing infective endocarditis (IE). Previous studies have reported recurrent IE, increased duration of hospital stay, poor adherence and compliance as well as higher mortality and worse outcomes after surgery in the IDU-IE patient group. Further studies are needed to provide a basis for optimized care and prevention of readmissions in this population. This study aims to describe the clinical characteristics and outcomes among patients with IDU-IE. Methods Data of adults with IDU-IE and non-IDU-IE, treated between 2008 and 2017 at the Karolinska University Hospital in Stockholm were obtained from the Swedish National Registry of Infective Endocarditis. Clinical characteristics, microbiological results, treatment durations, results from echocardiography and in-hospital mortality were compared between the groups. Results Of the total 522 patients, 165 (32%) had IDU-IE. Patients with IDU-IE were younger than the patients with non-IDU-IE (mean age IDU-IE: 41.6 years, SD 11.9 years; non-IDU-IE: 64.3 years, SD 16.4 years; P < 0.01). No difference in distribution of gender was observed, 33% were females in both the IDU-IE and the non-IDU-IE group. History of previous IE (IDU-IE: n = 49, 30%; non-IDU-IE: n = 34, 10%; P < 0.01) and vascular phenomena (IDU-IE: n = 101, 61%; non-IDU-IE: n = 120, 34%; P < 0.01) were more common among patients with IDU-IE while prosthetic heart valves (IDU-IE: n = 12, 7%; non-IDU-IE: n = 83, 23%; P < 0.01) and known valvular disease (IDU-IE: n = 3, 2%; non-IDU-IE: n = 78, 22%; P < 0.01) were more common among patients with non-IDU-IE. Aetiology of Staphylococcus aureus (IDU-IE: n = 123, 75%; non-IDU-IE: n = 118, 33%; P < 0.01) as well as tricuspid (IDU-IE: n = 91, 55%; non-IDU-IE: n = 23, 6%; P < 0.01) or pulmonary valve vegetations (IDU-IE: n = 7, 4%; non-IDU-IE: n = 2, 1%; P < 0.01) were more common in the IDU-IE group. The overall incidence of IDU-IE decreased during the study period, while the incidence of definite IE increased (P < 0.01). Conclusions This study presents that patients with IDU-IE were younger, less frequently treated with surgery and had higher prevalence of vascular phenomena and history of previous IE, aspects that are important for improved management of this population.

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1268. Dalbavancin for the Treatment of Infections due to Staphylococcus aureus

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1452 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S650-S651

Author(s):

Amber C Streifel ◽

Ellie Sukerman ◽

Monica Sikka ◽

Jina Makadia ◽

James Lewis ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Clinical Outcomes ◽

Adverse Drug Events ◽

Joint Infection ◽

Standard Of Care ◽

Clinical Endpoints ◽

History Of ◽

Antibiotic Failure ◽

Iv Drug Use ◽

Infection Recurrence

Abstract Background Dalbavancin is a lipoglycopeptide antibiotic active against gram-positive organisms. Its extended half-life allows for weekly dosing that can last 4 to 6 weeks with 2 doses. Although approved for treating skin and soft tissue infections, use for more complicated infections is appealing, particularly when daily intravenous antibiotics are impractical. S aureus is the most common cause of complex infections for which dalbavancin is considered at our institution, so we sought to better understand its use. Methods We conducted a retrospective study to describe dalbavancin use at our institution for infections caused by Staphylococcus aureus. We identified all patients ≥18 years who received ≥1 dose of dalbavancin. Infectious disease faculty reviewed charts for clinical characteristics and outcomes of the infections. Results Fifty-two patients with S. aureus infections (60% MRSA) were treated with at least a partial course of dalbavancin. Twenty-seven (52%) had a history of IV drug use (IDU) and the most common infections were bone and joint infection in 51% and bacteremia in 40% (Table 1). The most common dosing regimen was 1500 mg x 1 in 55% or 1500 mg weekly x 2 in 25% (Table 2). The most common reasons for use of dalbavancin were history of IDU in 48% and lack of a safe home environment in 21%. Suppressive oral antibiotics for the primary infection were prescribed to 3 patients after completing dalbavancin (2 received for other indications). Clinical outcomes include 15% of patients lost to follow-up, readmission due to infection recurrence or dalbavancin adverse effects in 12%, and overall infection recurrence or relapse by day 90 in 31% (Table 3). There were no severe dalbavancin-related adverse drug events. Table 1. Patient and Disease Characteristics Table 2. Dalbavancin Use Characteristics Table 3. Clinical Endpoints Conclusion While our results suggest dalbavancin is well tolerated, questions about relapse rates in the treatment of complicated S. aureus infections remain. Further research is needed to evaluate clinical outcomes for dalbavancin compared to standard of care antibiotics and to better elucidate whether relapses were related to true antibiotic failure versus other complexities of the S. aureus infections. Disclosures All Authors: No reported disclosures

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Psychosocial adjustment, coping, and quality of life in persons with venous ulcers and a history of intravenous drug use

Journal of Wound Ostomy and Continence Nursing ◽

10.1067/mjw.2000.107877 ◽

2000 ◽

Vol 27 (4) ◽

pp. 0227-0237 ◽

Cited By ~ 3

Author(s):

Barbara Pieper ◽

Kristin Szczepaniak ◽

Thomas Templin

Keyword(s):

Quality Of Life ◽

Drug Use ◽

Psychosocial Adjustment ◽

Intravenous Drug ◽

Intravenous Drug Use ◽

Venous Ulcers ◽

History Of

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Drug use, injecting behaviors, and survival sex among street children and youths in Kathmandu valley, Nepal

International Journal of STD & AIDS ◽

10.1177/0956462417746532 ◽

2017 ◽

Vol 29 (6) ◽

pp. 588-597 ◽

Cited By ~ 3

Author(s):

Sampurna Kakchapati ◽

Bishnu Shrestha ◽

Dan Y Li ◽

Rajesh Rajbhandari ◽

Tarun Poudel

Keyword(s):

Drug Use ◽

Condom Use ◽

Risk Behaviors ◽

Street Children ◽

Coping Mechanisms ◽

Kathmandu Valley ◽

Cross Sectional ◽

Survival Sex ◽

History Of ◽

Disproportionate Number

A disproportionate number of street children use and inject drugs and engage in survival sex as coping mechanisms. This study aimed to determine the prevalence of drug use, injecting drugs, survival sex, and condom use and determinants associated with these behaviors among street children. Cross-sectional surveys were conducted in 2016 with an aim to sample 350 street children and youths in Kathmandu Valley, Nepal. Information about sociodemographic characteristics, injecting drugs, sexual risk behaviors, and biological specimens for HIV testing were obtained. The logistic regression model was used to identify the determinants associated with drug use, injecting drugs, survival sex, and condom use during last sex. Variables that were significantly associated with being a current drug user (versus never) in the presence of other variables included being a rag picker (adjusted odds ratio [AOR] = 3.2; 95% confidence interval [95% CI] = 1.73–5.9), history of imprisonment (AOR = 2.21; 95% CI = 1.21–4.04), alcohol consumption (AOR = 2.66; 95% CI = 1.46–4.84), and solvent sniffing (AOR = 5.12; 95% CI = 2.74–9.59). Variables that were significantly predictive of injecting drugs (versus never) in the presence of other variables include being 17 years old (AOR = 3.42; 95% CI = 1.11–10.55) and being a rag picker (AOR = 3.5; 95% CI = 1.25–9.75). Variables that were significantly associated with having survival sex (versus never) in the presence of other variables include being 17 years old (AOR = 3.58; 95% CI = 1.31–9.81) and having forced sex (AOR = 9.62; 95% CI = 3.21–28.8). Drug use and survival sex are major coping mechanisms among street children in Kathmandu Valley and are associated with many risk behaviors. Targeted programs should be implemented to meet their special needs.

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Lifetime and past-month substance use and injection among street-based female sex workers in Iran

Harm Reduction Journal ◽

10.1186/s12954-021-00477-5 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Payam Roshanfekr ◽

Mehrdad Khezri ◽

Salah Eddin Karimi ◽

Meroe Vameghi ◽

Delaram Ali ◽

...

Keyword(s):

Alcohol Use ◽

Drug Use ◽

Injection Drug Use ◽

Sex Workers ◽

Female Sex Workers ◽

Injection Drug ◽

Logistic Regression Models ◽

Female Sex ◽

History Of ◽

Group Sex

Abstract Background Street-based female sex workers (FSWs) are highly at risk of HIV and other harms associated with sex work. We assessed the prevalence of non-injection and injection drug use and their associated factors among street-based FSWs in Iran. Methods We recruited 898 FSWs from 414 venues across 19 major cities in Iran between October 2016 and March 2017. Correlates of lifetime and past-month non-injection and injection drug use were assessed through multivariable logistic regression models. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were reported. Results Lifetime and past-month non-injection drug use were reported by 60.3% (95% CI 51, 84) and 47.2% (95% CI 38, 67) of FSWs, respectively. The prevalence of lifetime and past-month injection drug use were 8.6% (95% CI 6.9, 10.7) and 3.7% (95% CI 2.6, 5.2), respectively. Recent non-injection drug use was associated with divorced marital status (AOR 2.00, 95% CI 1.07, 3.74), temporary marriage (AOR 4.31 [1.79, 10.40]), had > 30 clients per month (AOR 2.76 [1.29, 5.90]), ever alcohol use (AOR 3.03 [1.92, 6.79]), and history of incarceration (AOR 7.65 [3.89, 15.30]). Similarly, lifetime injection drug use was associated with ever alcohol use (AOR 2.74 [1.20–6.20]), ever incarceration (AOR 5.06 [2.48–10.28]), and ever group sex (AOR 2.44 [1.21–4.92]). Conclusions Non-injection and injection drug use are prevalent among street-based FSWs in Iran. Further prevention programs are needed to address and reduce harms associated with drug use among this vulnerable population in Iran.

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