A Proposal for Addiction and Infectious Diseases Specialist Collaboration to Improve Care for Patients With Opioid Use Disorder and Injection Drug Use Associated Infective Endocarditis

Abstract Background No International Classification of Diseases, 10th revision (ICD-10), diagnosis code exists for injection drug use–associated infective endocarditis (IDU-IE). Instead, public health researchers regularly use combinations of nonspecific ICD-10 codes to identify IDU-IE; however, the accuracy of these codes has not been evaluated. Methods We compared commonly used ICD-10 diagnosis codes for IDU-IE with a prospectively collected patient cohort diagnosed with IDU-IE at Barnes-Jewish Hospital to determine the accuracy of ICD-10 diagnosis codes used in IDU-IE research. Results ICD-10 diagnosis codes historically used to identify IDU-IE were inaccurate, missing 36.0% and misclassifying 56.4% of patients prospectively identified in this cohort. Use of these nonspecific ICD-10 diagnosis codes resulted in substantial biases against the benefit of medications for opioid use disorder (MOUD) with relation to both AMA discharge and all-cause mortality. Specifically, when data from all patients with ICD-10 code combinations suggestive of IDU-IE were used, MOUD was associated with an increased risk of AMA discharge (relative risk [RR], 1.12; 95% CI, 0.48–2.64). In contrast, when only patients confirmed by chart review as having IDU-IE were analyzed, MOUD was protective (RR, 0.49; 95% CI, 0.19–1.22). Use of MOUD was associated with a protective effect in time to all-cause mortality in Kaplan-Meier analysis only when confirmed IDU-IE cases were analyzed (P = .007). Conclusions Studies using nonspecific ICD-10 diagnosis codes for IDU-IE should be interpreted with caution. In the setting of an ongoing overdose crisis and a syndemic of infectious complications, a specific ICD-10 diagnosis code for IDU-IE is urgently needed.

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Association of Treatment With Medications for Opioid Use Disorder With Mortality After Hospitalization for Injection Drug Use–Associated Infective Endocarditis

JAMA Network Open ◽

10.1001/jamanetworkopen.2020.16228 ◽

2020 ◽

Vol 3 (10) ◽

pp. e2016228 ◽

Cited By ~ 2

Author(s):

Simeon D. Kimmel ◽

Alexander Y. Walley ◽

Yijing Li ◽

Benjamin P. Linas ◽

Sara Lodi ◽

...

Keyword(s):

Infective Endocarditis ◽

Drug Use ◽

Injection Drug Use ◽

Opioid Use Disorder ◽

Injection Drug ◽

Opioid Use

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Adverse childhood experience effects on opioid use initiation, injection drug use, and overdose among persons with opioid use disorder

Drug and Alcohol Dependence ◽

10.1016/j.drugalcdep.2017.07.007 ◽

2017 ◽

Vol 179 ◽

pp. 325-329 ◽

Cited By ~ 35

Author(s):

Michael D. Stein ◽

Micah T. Conti ◽

Shannon Kenney ◽

Bradley J. Anderson ◽

Jessica N. Flori ◽

...

Keyword(s):

Drug Use ◽

Injection Drug Use ◽

Opioid Use Disorder ◽

Injection Drug ◽

Adverse Childhood Experience ◽

Opioid Use ◽

Childhood Experience ◽

Adverse Childhood ◽

Experience Effects

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Low Knowledge of HIV PrEP Within a Midwestern U.S. Cohort of Persons Who Inject Drugs

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab541 ◽

2021 ◽

Author(s):

Sena Sayood ◽

Laura R Marks ◽

Rupa Patel ◽

Nathanial S Nolan ◽

Stephen Y Liang ◽

...

Keyword(s):

Drug Use ◽

Hiv Infection ◽

Sexual Intercourse ◽

Injection Drug Use ◽

Opioid Use Disorder ◽

Injection Drug ◽

Opioid Use ◽

Persons Who Inject Drugs

Abstract We interviewed persons who inject drugs (PWID) to understand perceptions of PrEP to prevent HIV infection. Knowledge of PrEP was poor. Patients felt PrEP was for sexual intercourse rather than injection drug use, and PWID managed on medications for opioid use disorder (MOUD) felt they had no need for PrEP.

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New Answers for Old Questions in the Treatment of Severe Infections from Injection Drug Use

Journal of Hospital Medicine ◽

10.12788/jhm.3342 ◽

2019 ◽

Vol 15 (10) ◽

pp. 606-612

Author(s):

David P Serota ◽

Theresa Vettese

Keyword(s):

Drug Use ◽

Injection Drug Use ◽

Opioid Use Disorder ◽

Trial Data ◽

Injection Drug ◽

Soft Tissue Infections ◽

Opioid Use ◽

Surgical Interventions ◽

Care Plans ◽

Severe Infections

Hospitalists are increasingly responsible for the management of infectious consequences of opioid use disorder (OUD), including increasing rates of hospitalization for injection drug use (IDU)-associated infective endocarditis, osteomyelitis, and soft tissue infections. Management of IDU-associated infections poses unique challenges: symptoms of the underlying addiction can interfere with care plans, patients often have difficult psychosocial circumstances in addition to their addiction, and they are often stigmatized by the healthcare system. Although there are few randomized trial data to support one particular approach to management, the literature suggests that successful treatment of IDU-associated infections requires appropriate antimicrobial and surgical interventions in addition to acknowledgment and treatment of the underlying OUD. In this narrative review, the best available evidence is used to answer several of the most commonly encountered questions in the management of IDU-associated infections. These data are used to develop a framework for hospitalists to approach the care of patients with IDU-associated infections.

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1020. Injection Drug Use-Associated Staphylococcus aureus Bacteremia in a Large Urban Hospital in Atlanta, Georgia

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.857 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S304-S304

Author(s):

David P Serota ◽

Colleen Kelley ◽

Jesse T Jacob ◽

Susan M Ray ◽

Marcos C Schechter ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Drug Use ◽

Injection Drug Use ◽

Infectious Complications ◽

Opioid Use Disorder ◽

Injection Drug ◽

First Episode ◽

Opioid Use ◽

Urban Hospital ◽

Multiple Drugs

Abstract Background Infectious complications of injection drug use (IDU) have increased with the expanding opioid epidemic in the southeast. We assessed the incidence, clinical presentation, and treatment outcomes of IDU-associated Staphylococcus aureus (SA) bacteremia (SAB). Methods We created a retrospective cohort of all adults with community acquired (CA) SAB over 5 years presenting to Grady Memorial Hospital, a 1,000-bed urban county hospital in Atlanta, GA. Charts were reviewed by infectious diseases physicians to obtain clinical and laboratory characteristics, including substance use disorder (SUD), and determine if SAB was IDU-associated. The study period was divided into three periods (P1 = March 2012–January 2014, P2 = January 2014–December 2015, P3 = December 2015–November 2017) to evaluate changes in the incidence of IDU-SAB over time using Poisson regression. Results Among 321 patients with a first episode of CA-SAB, 24 (7%) were IDU-SAB. The number of IDU-SAB cases in each period increased (P1 = 4, P2 = 7, and P3 = 13 [P = 0.07 for trend]). The median age of IDU-SAB patients was 38 (IQR 31–57), 11 (46%) were black, and 15 (63%) had chronic hepatitis C virus infection. Heroin was the most common injected drug (92%) followed by cocaine (25%); multiple drugs were injected in 29%. All but two patients (92%) had a complication of SAB, most commonly endocarditis (50%) and septic pulmonary emboli (38%). The median hospitalization was 23 days (IQR 19.5–37.5) and 5 patients (12%) left the hospital against medical advice (AMA). Readmission for persistent or recurrent SA infection during the study period was common (42%), and three (13%) died ≤6 months from initial presentation, including two with prior discharge AMA. Half of the discharge summaries did not mention SUD as a hospital problem. Outpatient SUD treatment was recommended to eight (33%) patients and a recommendation of abstinence was the intervention for 12 (50%). Conclusion Increasing IDU-SAB was observed over 5 years in our urban Atlanta hospital, primarily due to heroin use. Most cases were associated with complications of SAB with a long length of stay and frequent readmission, but few patients received treatment or harm reduction interventions for their SUD. These data will raise awareness and direct resources to expanding evidence-based opioid use disorder treatment for patients with infectious complications of IDU. Disclosures All authors: No reported disclosures.

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890. Bridging the Gap to Help Address the Opioid Crisis: A Novel Model of Care to Integrate Substance Use, Mental Health, and Infectious Disease Services

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz359.049 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S22-S22

Author(s):

Kimberly Corace ◽

Nicholas Schubert ◽

Melanie Willows ◽

Guy Herbert ◽

Gary Garber

Keyword(s):

Mental Health ◽

Infectious Disease ◽

Substance Use ◽

Drug Use ◽

Infectious Diseases ◽

Injection Drug Use ◽

Injection Drug ◽

Opioid Use ◽

Care Model ◽

Rapid Access

Abstract Background There is a converging public health crisis as the opioid epidemic and increased injection drug use is driving rates of infectious diseases. Multidisciplinary care, integrating infectious diseases, substance use, and mental health services, is crucial to address this crisis. This study evaluated a novel rapid access care model to improve treatment access for opioid use, mental health, and related infectious diseases. Methods The Rapid Access Addiction Medicine (RAAM) clinic is a multidisciplinary, walk-in care model located in a mental health center in Ottawa, Canada. RAAM provides collaborative, inter-agency care, with rapid access to care facilitated through seamless care pathways (i.e., from the emergency department). RAAM offers substance use and mental health treatment, screening and care for infectious diseases, harm reduction, and connection to community services. RAAM patients (N = 411) presenting between April 2018 and January 2019 completed substance use and mental health measures upon intake and 30-day follow-ups. Clinical information was collected via chart review. Results Of the total sample, 20% (n = 83; 66% men) had problematic opioid use. Most patients reported high opioid dependence severity (97%), injection drug use (67%), and polysubstance use (97%), including cocaine (62%), alcohol (40%), and amphetamines (35%). Most patients reported anxiety (86%) and depression (75%). The number of patients tested for HIV, HCV, HBV, and other STIs was 29%, 27%, 28%, and 24%, respectively. Most patients tested (61%) were young adults (aged 16–29). Of those tested, 15% tested positive for HCV and treatment initiation was facilitated for 66% of patients (33% resolved spontaneously). At 30-day follow-up, patients showed significantly reduced substance use and improved depression and anxiety (Ps < 0.05). Conclusion Patients with problematic opioid use have multiple comorbidities, including undiagnosed infectious diseases; thus, highlighting the need for integrated care models like RAAM. Substance use treatment is an opportune setting to identify and treat infectious diseases in order to improve outcomes and reduce disease transmission. Leadership from infectious disease specialists is key to this successful integration. 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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