DAT- Integrated Outpatient Treatment of Opioid Use Disorder and Injection-Related Infections

摘要 DAT18-06：阿片类药物使用障碍并发症的住院治疗，如感染性心内膜炎和 其他严重的注射相关感染(SIRI)随着阿片类药物的流行而急剧增加。 因Siri而住院的OUD患者通常仍需住院以完成延长的静脉注射(IV) 抗生素疗程源于几个假设，例如1)如果门诊，患者将向静脉注射违禁药物 2)如果住院，患者将不会注射药物 由于监管力度加大，将完成抗生素治疗方案。没有证据支持这些观点 假设，不幸的是，住院不仅对医疗系统来说非常昂贵，而且 很少包括全面的OUD治疗。相比之下，门诊非肠道抗生素治疗 (Opat)经外周静脉插入中心静脉导管(PICC)是继续静脉用药的标准护理 对于没有注射用药(IDU)的患者，药物一度稳定，常用于治疗 需要长时间静脉注射抗生素的感染。OPAT具有成本效益，与患者病情改善相关 满意度，降低了医院获得性感染的风险。发展创新型门诊 迫切需要临床模式来改进对OUD患者的管理和过渡计划 Siri，考虑到与长时间住院相关的成本和风险。我们进行了一次成功的试点， 一项概念验证、随机研究，旨在确定住院患者出院的安全性和可行性。 和Siri在结合BUP治疗的创新、集成的门诊模式中完成静脉抗生素 使用OPAT。这项为期12周的门诊、随机、平行分组研究建立在我们的初步工作基础上 展示综合门诊护理模式(B-OPAT：BUP加OPAT治疗)的有效性。病人 使用OUD和Siri将被随机(1：1)分为B-OPAT(n=45)或照常治疗(TAU)(n=45) 比较非法阿片类药物尿样阴性和危重尿样比例的初步结果 二次结果，包括推荐的静脉抗生素治疗完成，自我报告的天数 门诊治疗中的非法阿片类药物戒断和滞留。这项研究还将纳入一项 综合门诊服务模式的综合经济评价及定性评价 进行调查，为今后的实施和传播提供信息。这些结果将证明其有效性。 以及提供OUD和SIRI门诊治疗的综合门诊护理模式的成本效益 住院后。

ABSTRACT DAT18-06: Hospitalizations for complications of opioid use disorder (OUD), like infectious endocarditis (IE) and other severe, injection-related infections (SIRI), have increased dramatically along with the opioid epidemic. Persons with OUD hospitalized with SIRI, often remain inpatient to complete prolonged intravenous (IV) antibiotic courses due to several assumptions such as 1) if outpatient, patients will inject illicit drugs into the IV catheter and will fail to complete prescribed antibiotic regimens, and 2) if inpatient, patients will not inject drugs because of the increased supervision and will complete the antibiotic regimen. No evidence supports these assumptions, and unfortunately, the inpatient stay is not only very costly to the healthcare system, but infrequently includes comprehensive OUD treatment. In contrast, outpatient parenteral antibiotic therapy (OPAT) via a peripherally-inserted central catheter (PICC) is the standard of care for continuing IV medications for patients without injection drug use (IDU) once medically stable, and is commonly used in treatment infections requiring prolonged IV antibiotics. OPAT is cost-effective, associated with improved patient satisfaction, and with decreased risks of hospital-acquired infections. Development of innovative outpatient clinical models is urgently needed to improve the management and transition plan of persons with OUD and SIRI, given the costs and risks associated with prolonged hospitalizations. We conducted a successful pilot, proof-of-concept, randomized, study to establish the safety and feasibility of discharging inpatients with OUD and SIRI to complete IV antibiotics in an innovative, integrated, outpatient model combining BUP treatment with OPAT. This 12-week outpatient, randomized, parallel-group study builds on our preliminary work to demonstrate efficacy of the integrated outpatient care model (B-OPAT: BUP treatment with OPAT). Patients with OUD and SIRI will be randomized (1:1) to either B-OPAT (n=45) or treatment-as-usual (TAU) (n=45) and compared on the primary outcome of the proportion of urine samples negative for illicit opioids, and on critical secondary outcomes including completion of recommended IV antibiotic therapy, self-reported number of days of illicit opioid abstinence and retention in outpatient treatment. The study will also incorporate a comprehensive economic evaluation of the integrated outpatient care model as well as a qualitative investigation to inform future implementation and dissemination. These results will demonstrate the efficacy and cost effectiveness of an integrated outpatient care model to provide outpatient treatment of OUD and SIRI after hospitalization.