Improved Outcomes Following Integrated Infectious Disease and Opioid Use Disorder Care for Homeless Individuals

Individuals experiencing homelessness who had opioid use disorder (OUD) and were hospitalized for serious infections were more likely to have a clinical cure of their infection and to be retained in addiction care after receiving integrated infectious disease and OUD care, according to the results of a study published in Open Forum Infectious Diseases.

Patients (N=53) admitted to Harborview Medical Center in the United States with severe infections between 2018 and 2020 were enrolled in this study. All study participants were experiencing homelessness and had OUD. Patients received an infectious diseases consultation, an addiction consultation, referral for community-based services, and OUD medications (buprenorphine ≥16 mg/d or methadone ≥80 mg/d). Through 90 days, patients were assessed for clinical cure and retention in addiction treatment.

Patients were 70% men, the median age was 39 years, 79% were White, 71% had injected drugs in the past 3 months, 19% used non-injection drugs, and 65% used heroin or opioids plus stimulants.

Patients were diagnosed with osteomyelitis (73%), bacteremia (43%), septic joint (24%), epidural abscess (16%), confirmed endocarditis (8%), presumed endocarditis (8%), psoas abscess (6%), pulmonary infection (3%), intra-abdominal infected pseudoaneurysm (1.6%), and endophthalmitis (1.6%). Infectious organisms included methicillin-resistant Staphylococcus aureus (48%), methicillin-susceptible S aureus (24%), and Streptococcus (24%). Half (49%) of infections were caused by multidrug-resistant organisms.

The median length of hospital stay was 12 days and medical respite was 23 days. Nearly half (44%) were readmitted within 90 days due to osteomyelitis (n=21), bacteremia (n=13), endocarditis (n=4), epidural abscess (n=3), psoas abscess (n=2), intra-abdominal infected pseudoaneurysm (n=1), and pulmonary infections (n=1).

Patients received an infectious disease consultation (92%), an addiction consultation (51%), medications for OUD (86%), and case management (59%). Patients were given buprenorphine (n=26) or methadone (n=28). At admission, 22 patients were already using medications for OUD.

Half of patients (49%) successfully completed their antibiotic course. One patient died from drug overdose and another from end-stage renal disease.

Patients who received all 4 interventions (38.1%) were more likely to have clinical cure at 90 days (aOR, 3.03; 95% CI, 1.00-9.15; P =.049) and remain in addiction care at 30 days (aOR, 6.36; 95% CI, 1.84-21.95; P =.003).

This study may be limited by its high number of patients lost during follow-up (n=30).

These data indicated that integrated infectious disease and OUD care increased the likelihood of achieving clinical cure of infection and remaining in addiction treatment at 90 days.

Reference

Beieler AM, Klein JW, Bhatraju E, Iles-Shih M, Enzian L, Dhanireddy S. Evaluation of bundled interventions for patients with opioid use disorder experiencing homelessness receiving extended antibiotics for severe infection. Open Forum Infect Dis. Published online May 29, 2021. doi:10.1093/ofid/ofab285