Injection drug use (IDU) is a risk factor for severe infections including bacteremia and infective endocarditis. Patients who develop these infections are treated with intravenous antibiotics in the hospital and continued on IV antibiotics via OPAT using a peripherally inserted central venous catheter (PICC) after discharge. People who inject drugs (PWID) have traditionally been excluded from this model of treatment out of concern that they might use a PICC to inject drugs, precipitating venous thrombosis, catheter-associated bloodstream infection, infective endocarditis, or other catheter complications. Unfortunately, alternative treatment strategies (e.g. continued inpatient IV therapy, or discharge with oral antibiotics) are limited by patient non-adherence, particularly when the underlying substance use disorder is not addressed.
Recent data have challenged the notion that PWID cannot be treated with OPAT. A recent literature review by Suzuki et al found that PWID completed OPAT in 72-100% of cases and that rates of treatment failure, readmission, and mortality comparable to non-PWID [1]. Eaton et al validated a risk assessment tool for failure of OPAT in PWID in clinical practice [2]. Fanucchi et al have pioneered a new model of integrated care of opiate use disorder and injection-related infections with MAT and OPAT and have shown that this approach achieves infection cure and drug use outcomes similar to or better than usual care while achieving a >3 week mean reduction in length of stay [3-4]. Multiple centers across areas of the US where opioid use disorder is endemic are adopting this new model of treatment.
Nicolas Cortes-Penfield, MD, shared that this guideline will be available under the Antimicrobial Stewardship Program and Clinical Pathways and Guidance in the near future.
Guidelines for use of OPAT in combination with MAT for people who inject drugs
