Follow-up Care Is Essential for Injection Drug Use-Associated Bone and Joint Infections

Partial-oral antibiotic therapy for bone and joint infections in patients who use injectable drugs is most likely to be effective when coupled with postdischarge follow-up care. These study results were published in Open Forum Infectious Diseases.

Researchers performed a retrospective study at an urban teaching hospital to assess outcomes of partial-oral antibiotic therapy among patients with BJIs who reported injection drug use within the past 3 months. The primary outcomes were treatment failure and cure. Treatment failure was defined as clinical signs or symptoms indicating worsening or recurrent infection within 90 or 180 days of treatment completion. Univariate logistic regression was used to determine associations between clinical variables at baseline and the occurrence of treatment failure.

There were 86 patients included in the final analysis, of whom 12 received only intravenous (IV) antibiotic therapy, and 74 received planned partial-oral antibiotic therapy or reactive antibiotic therapy. The median patient age was 44 years, 20% were men, 85% were white, and 6% had HIV infection at baseline. Among all patients, the most common site of infection was the spine (58%), and methicillin-susceptible Staphylococcus aureus and (37%) and methicillin-resistant S aureus (MRSA; 41%) were the most commonly isolated pathogens.

At days 90 and 180, treatment failure occurred among 18% and 20% of patients who received planned partial-oral antibiotic therapy, respectively. For patients who received only IV antibiotics, treatment failure occurred among 50% at 90 days and 58% at 180 days.

Factors associated with decreased risk for treatment failure included homelessness at hospital admission and postdischarge medical respite and follow-up care with infectious disease or surgery. Of note, the association between homelessness and decreased risk for treatment failure was likely mediated by postdischarge medical respite.

Limitations of this study include the observational design, the small sample size, and the use of self-reported data on injection drug use.

According to the researchers, “Our practice experience demonstrated that successful treatment of PWID [patients who inject drugs] with BJI was attainable with planned partial-oral antibiotics within the context of support services and post-discharge care coordination.”