Infectious disease complications associated with opioid use disorder at a southern county hospital: a retrospective chart review

TL;DR

This study examines infectious diseases linked to opioid use disorder in a southern US hospital, finding high rates of skin infections and increased medication uptake.

Contribution

The study provides insights into IDU-associated infections and MOUD uptake in a southern US hospital, highlighting regional healthcare disparities.

Findings

Skin and soft-tissue infections were the most common IDU-associated infections, often polymicrobial.

Patients with IDU-associated infections had higher new MOUD uptake compared to those without infections.

Methicillin-resistant Staphylococcus aureus was the most frequently identified organism.

Abstract

Injection drug-use (IDU) is related to significant morbidity and mortality. Recent studies of IDU-associated infections have primarily focused on regions outside of the southern US. However, this area presents greater barriers to healthcare funding and lower availability of harm reduction services such as syringe service programs. In this study, we sought to describe infectious disease burden, uptake of medication for opioid use disorder (MOUD), and healthcare utilization in patients with opioid use disorder (OUD) who received inpatient addiction psychiatry consultation at a large safety-net hospital in the southern US.

A retrospective electronic health record review was conducted for patients admitted to an urban county hospital from February 2018-February 2020. Inclusion criteria: (a) OUD within the last 12 months and (b) addiction psychiatry consultation. Baseline characteristics were compared between those with and without IDU-associated infections. IDU-associated infections, cultured microbes, and MOUD uptake were described.

Of 283 charts reviewed, 248 individuals met inclusion criteria. Overall, 65% were male, 48% non-Hispanic white, and 34% Hispanic. In total, 72% reported opioid IDU in the past 30 days and 52% had IDU-associated infections, including skin and soft-tissue infections (SSTI) (49%), bacteremia (17%), osteomyelitis, (7%), and endocarditis (5%). Comorbid stimulant use disorder was frequently reported (70%). Methicillin-resistant Staphylococcus aureus was the most common organism identified (24%). Though 40% of IDU-associated infections were monomicrobial, 23% were polymicrobial (including anaerobes, gram-negatives, and yeast species). Those with IDU-associated infections had lower rates of MOUD on admission (8% vs. 32%) but had higher new MOUD uptake (81% vs. 51%).

SSTIs, which were often polymicrobial, comprised most IDU-associated infections among inpatients with OUD hospitalized in an urban Texas hospital. Individuals with IDU-associated infections had increased MOUD uptake. These findings have implications for empiric antibiotic management of IDU-associated infections and support inpatient initiation of substance use treatment.