Young Jo1,2, Rebecca Nosal1,3, Angela Vittori1,2, Leopold Cordova4,5, Christian Vandever1,6, Clara Alvarez1,2, Tyler S Bartholomew7, Hansel E Tookes5. 1. HCA Healthcare, Nashville, TN, USA. 2. Department of Psychiatry, Aventura, Aventura Hospital and Medical Center, FL, USA. 3. Department of Psychiatry, University Hospital and Medical Center, Tamarac, FL, USA. 4. Department of Medicine, Jackson Memorial Hospital, Miami, FL, USA. 5. Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA. 6. HCA Graduate Medical Education Research, Nashville, TN, USA. 7. Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
Abstract
BACKGROUND AND AIMS: Opioid use disorder (OUD) has led to not only increases in overdose deaths, but also increases in endocarditis and osteomyelitis secondary to injection drug use (IDU). We studied the association between initiation of medications for opioid use disorder (MOUD) and treatment outcomes for people with infectious sequelae of IDU and OUD. DESIGN AND SETTING: This is a retrospective cohort study reviewing encounters at 143 HCA Healthcare hospitals across 21 states of the United States from 2014 to 2018. PARTICIPANTS: Adults aged 18-65 with the ICD diagnosis code for OUD and endocarditis or osteomyelitis (n = 1407). MEASUREMENTS: Main exposure was the initiation of MOUD, defined as either methadone or buprenorphine at any dosage started during hospitalization. Primary outcomes were defined as patient-directed discharge (PDD), 30-day re-admission and days of intravenous antibiotic treatment. Covariates included biological sex, age, ethnicity, other co-occurring substance use disorders, and insurance status. FINDINGS: MOUD was initiated among 269 (19.1%) patients during hospitalization. Initiation of MOUD was not associated with decreased odds of PDD. Initiation of MOUD did not impact 30-day re-admission. Patients who received MOUD, on average, had 5.7 additional days of gold-standard intravenous antibiotic treatment compared with those who did not [β = 5.678, 95% confidence interval (CI) = 3.563, 7.794), P < 0.05]. CONCLUSION: For people with opioid use disorder hospitalized with endocarditis or osteomyelitis, initiation of methadone or buprenorphine appears to be associated with improved receipt of gold-standard therapy, as quantified by increased days on intravenous antibiotic treatment.
BACKGROUND AND AIMS: Opioid use disorder (OUD) has led to not only increases in overdose deaths, but also increases in endocarditis and osteomyelitis secondary to injection drug use (IDU). We studied the association between initiation of medications for opioid use disorder (MOUD) and treatment outcomes for people with infectious sequelae of IDU and OUD. DESIGN AND SETTING: This is a retrospective cohort study reviewing encounters at 143 HCA Healthcare hospitals across 21 states of the United States from 2014 to 2018. PARTICIPANTS: Adults aged 18-65 with the ICD diagnosis code for OUD and endocarditis or osteomyelitis (n = 1407). MEASUREMENTS: Main exposure was the initiation of MOUD, defined as either methadone or buprenorphine at any dosage started during hospitalization. Primary outcomes were defined as patient-directed discharge (PDD), 30-day re-admission and days of intravenous antibiotic treatment. Covariates included biological sex, age, ethnicity, other co-occurring substance use disorders, and insurance status. FINDINGS: MOUD was initiated among 269 (19.1%) patients during hospitalization. Initiation of MOUD was not associated with decreased odds of PDD. Initiation of MOUD did not impact 30-day re-admission. Patients who received MOUD, on average, had 5.7 additional days of gold-standard intravenous antibiotic treatment compared with those who did not [β = 5.678, 95% confidence interval (CI) = 3.563, 7.794), P < 0.05]. CONCLUSION: For people with opioid use disorder hospitalized with endocarditis or osteomyelitis, initiation of methadone or buprenorphine appears to be associated with improved receipt of gold-standard therapy, as quantified by increased days on intravenous antibiotic treatment.
Authors: Sabrina Taldone; Sandra Lemmon; Suzy Bianco; Joan St Onge; Henri Ford; Lindsay Cox; David P Serota; Sabita Roy; Jason Onugha; David W Forrest; Tyler Bartholomew; Hansel E Tookes Journal: MedEdPORTAL Date: 2022-05-10
Authors: Thomas D Brothers; Kimiko Mosseler; Susan Kirkland; Patti Melanson; Lisa Barrett; Duncan Webster Journal: PLoS One Date: 2022-01-26 Impact factor: 3.240
Authors: David P Serota; Hansel E Tookes; Belén Hervera; Babley M Gayle; Cara R Roeck; Edward Suarez; David W Forrest; Michael A Kolber; Tyler S Bartholomew; Allan E Rodriguez; Susanne Doblecki-Lewis Journal: Ann Med Date: 2021-12 Impact factor: 5.348