A Comparison of Medication for Opioid Use Disorder Treatment Strategies for Persons Who Inject Drugs With Invasive Bacterial and Fungal Infections
A Comparison of Medication for Opioid Use Disorder Treatment Strategies for Persons Who Inject Drugs With Invasive Bacterial and Fungal Infections
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DOI：
10.1093/infdis/jiz516
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发表时间：
2020-10-01
影响因子：
6.4
通讯作者：
Durkin, Michael J.
中科院分区：
文献类型：
--
作者：
Marks, Laura R.;Munigala, Satish;Durkin, Michael J.
背景阿片类药物使用障碍（OUD）患者经常因侵入性感染而入院。治疗OUD（MOUD）的药物可能会改善住院患者的预后。在这一回顾性队列中，有220例因OUD而进入三级护理中心的侵袭性感染患者，我们比较了4种MOUD治疗策略：美沙酮、丁丙诺啡、美沙酮减量解毒和不用药，以确定是否有肠外抗生素完成率和再入院率的差异。MOUD与肠外抗菌治疗完成率增加相关（64.08% vs 46.15%;比值比[OR] = 2.08; 95% CI，1.23-3.61）。在多变量分析中，使用MOUD维持与丁丙诺啡（OR = 0.38; 95%CI，0.17 - 0.85）或美沙酮维持（OR = 0.43; 95%CI，0.20 - 0.94）和出院时继续MOUD（OR = 0.35; 95%CI，0.18 - 0.67）与较低的90天再入院率相关。相比之下，使用美沙酮戒毒后逐渐减少药物治疗，出院后不继续使用，与再入院率下降无关（OR = 1.87; 95%CI，0.62 -5.10）。长期MOUD，无论选择如何，都是OUD相关感染住院患者护理的组成部分。OUD患者应安排在出院后继续使用MOUD，并且在出院前不应停止MOUD。
Background. Patients with opioid use disorder (OUD) are frequently admitted for invasive infections. Medications for OUD (MOUD) may improve outcomes in hospitalized patients.Methods. In this retrospective cohort of 220 admissions to a tertiary care center for invasive infections due to OUD, we compared 4 MOUD treatment strategies: methadone, buprenorphine, methadone taper for detoxification, and no medication to determine whether there were differences in parenteral antibiotic completion and readmission rates.Results. The MOUDs were associated with increased completion of parenteral antimicrobial therapy (64.08% vs 46.15%; odds ratio [OR] = 2.08; 95% CI, 1.23-3.61). On multivariate analysis, use of MOUD maintenance with either buprenorphine (OR = 0.38; 95% CI, .17-.85) or methadone maintenance (OR = 0.43; 95% CI, .20-.94) and continuation of MOUD on discharge (OR = 0.35; 95% CI, .18-.67) was associated with lower 90-day readmissions. In contrast, use of methadone for detoxification followed by tapering of the medication without continuation on discharge was not associated with decreased readmissions (OR = 1.87; 95% CI, .62-5.10).Conclusions. Long-term MOUDs, regardless of selection, are an integral component of care in patients hospitalized with OUD-related infections. Patients with OUD should have arrangements made for MOUDs to be continued after discharge, and MOUDs should not be discontinued before discharge.