257 - Staphylococcus aureus Bacteremia: Does Intravenous Drug Use Impact Quality of Care and Clinical Outcomes?

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Presenting Author(s)

Kristen McClellan

Medical Student
OHSU
Portland, Oregon
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

CH

Cami Hilsendager

Staff Physician
The Vancouver Clinic
Vancouver, Washington
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
SL

Strnad Luke

Assistant Professor of Medicine
Oregon Health and Science University and Portland State University School of Public Health
Portland, Oregon
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: Individuals with intravenous drug use (IDU) have higher risk for Staphylococcus aureus bacteremia (SAB) and increased management complexity. The goal of this study was to compare differences in SAB characteristics, adherence to standard of care metrics, and clinical outcomes in those with and without IDU.

Methods: A retrospective chart review was conducted on cases of SAB between January 1, 2016 and December 31, 2017 at a 500-bed teaching hospital. Inclusion criteria was age > 18 years and ≥ one blood culture positive for S. aureus. Patients were excluded if they transferred hospitals, had care withdrawn or died within 48 hours of diagnosis or had a ventricular assist device infection. Records were reviewed for substance use, SAB characteristics, standards of care, and outcomes. Data were analyzed using SPSS software. The study was approved by the Institutional Review Board.

Results: In 248 patients with SAB, 28.2% had documented IDU. Median age was 37 (IDU) and 57 (non-IDU). In the IDU group, 75.7% had the formal diagnosis of opioid use disorder and 78.9% of stimulant use disorder. IDU was associated with hepatitis C and houselessness while non-IDU was associated with diabetes, hemodialysis, and cancer. Those with IDU had higher rates of MRSA, endocarditis, and spinal infections, but did not have higher rates of polymicrobial infections or venous thrombosis. There was no difference in appropriate repeat blood cultures, antibiotic management, and ID consultation. Length of stay and against medical advice (AMA) discharges were higher in those with IDU. There was no difference in 90-day recurrence or readmission, but 90-day mortality was higher in the non-IDU group.Table 1. Patient Demographics

Table 2. Staphylococcus aureus Bacteremia Characteristics

Table 3. Staphylococcus aureus Bacteremia Standards of Care and Outcomes

Conclusion: There was no difference in adherence to SAB quality of care metrics between groups with and without IDU. Despite the IDU group being younger with fewer comorbidities, 90-day readmissions were not different between groups. This bears further analysis but may represent the influence of therapy completion, AMA discharges, and unmeasured social determinants of health.