![]() On occasions where patients were discharged with long-term antibiotics without enrollment in the OPAT database, they were identified through search of the electronic medical records (EMRs) (detailed methods in Supplementary Table 1). The patients were identified through an outpatient parental antibiotic therapy (OPAT) database maintained by the ID service. If injection drug use was not noted by these teams, it was assumed not to be present for the patient. Self-reported injection drug use was ascertained through documentation in clinical notes from the ID, addiction medicine, and/or admitting team. The date of February 1, 2019, was chosen to be the date of print publication of the OVIVA trial. Patients aged ≥18 with recent injection drug use (self-reported use within 3 months) and clinically diagnosed BJI by the treating teams (ID, orthopedic surgery, or spinal surgery) at HMC between February 1, 2019, and February 1, 2021, were analyzed. It is a public safety-net hospital for King County and a level-1 trauma and burn center for Washington, Wyoming, Alaska, Montana, and Idaho. We conducted a retrospective cohort study at a university-affiliated urban teaching hospital, Harborview Medical Center (HMC), located in Seattle, Washington. The aim of this study was to evaluate the frequency and outcomes of partial-oral antibiotic treatment in PWID with BJI. Inspired by the OVIVA trial, we define partial-oral antibiotic treatment as using oral antibiotics as part of a patient's treatment. The cure rate was lower than the 60%–90% cure rates reported by BJI studies that excluded PWID. A randomized clinical trial of early transition to oral vs prolonged IV antibiotics (OVIVA) for BJI demonstrated noninferiority of early transition to oral antibiotics, but the study excluded PWID.Ī prior study of PWID with BJI treated with prolonged IV antibiotics at our institution demonstrated a 50% cure rate, even with bundled interventions of infectious diseases (ID) consultation, addiction medicine consultation, case management, medications for opioid use disorder (MOUD), and postdischarge care in a medical respite. Īlternatives to IV antibiotic treatment are urgently needed for PWID with BJI to improve patient-centered care and reduce the cost of inpatient hospitalization, but the safety and efficacy of alternate approaches have not been well studied. Therefore, PWID frequently have patient-directed discharges (PDDs) and are often readmitted for the same or related problems, delaying management and increasing health care costs. However, this approach is resource-intensive and can diminish patient autonomy. Consequently, a common practice is to keep PWID with BJI in the hospital for the duration of the treatment course. ![]() Some care providers are reluctant to discharge PWID with indwelling intravenous catheters, fearing loss to follow-up, line tampering, and secondary bacteremia. ![]() Traditionally, 6–12 weeks of intravenous (IV) antibiotics has been recommended. Treatment of BJI for PWID can pose challenges. People who inject drugs (PWID) constitute a significant and increasing proportion of patients with bone and joint infections (BJIs).
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