707 - Infective Endocarditis and Medication Assisted Treatment in Opioid Use Disorder

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Presenting Author(s)

Katherine A. Loomis

Resident Physician
University of Southern California Keck School of Medicine
Los Angeles , California
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

CC

Catherine Canamar

Chief Research Analyst
Los Angeles County, University of Southern California Medical Center
Los Angeles, California
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MD

Michael Dubè

Professor of Medicine (Clinical Scholar); Interim Chief, Infectious Disease
University of Southern California
Los Angeles, California
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: A challenging feature in those with opioid use disorder-associated infective endocarditis (OUD-IE) is the duration and route of treatment, which often requires long inpatient stays. Those with OUD-IE often experience opioid withdrawal in the hospital, putting them at risk of leaving care prior to completion of treatment.
Initiation of medication-assisted treatment (MAT) with opioid agonists, including buprenorphine or methadone, has the potential to mitigate withdrawal and decrease morbidity and mortality among this high-risk population. We hypothesized that inpatient MAT will increase IE treatment adherence.

Methods: We conducted a single-center retrospective chart review study of adults (age > 18 years) with OUD-IE from 10/2015-09/2019. Vizient database was used to identify cases using ICD-9 and ICD-10 codes for IE and OUD. Manual chart review was done to confirm cases of OUD-IE using the modified Duke criteria for IE (Table 2) and evidence of active opioid use. Our primary outcome was treatment adherence defined as inpatient completion of treatment or transfer to another care facility for completion of treatment. Chi-squared test was used for categorical variables, t-test for continuous variables, and odds ratio (OR) with 95% confidence interval (CI) to evaluate our primary outcome.Table 2

Results: There were 49 confirmed patients with 89 unique admissions associated with OUD-IE (Figure 1). Of those, 71% were male, and the median age was 45 years (range 20-72). The majority were homeless (63%) and hepatitis C antibody positive (82%) (Table 1).
There were 81 evaluable admissions with 8 (9%) excluded due to intubation. Of those, 18 (22%) received inpatient MAT and 63 (78%) did not. Mortality rate was high, with 11 inpatient deaths. Among those admissions where MAT was given, 14 of 18 (78%) adhered to treatment, compared to 21 of 63 (33%) who did not receive MAT (p< 0.001). Significantly, only 4 of 18 (22%) who received MAT left AMA, compared 39 of 60 (65%) who did not receive MAT (p=0.001), excluding 3 who died. Those who received inpatient MAT were 7 times more likely to adhere to treatment (OR=7.0; 95% CI=2.05, 23.91) compared to those who did not (Table 3).Figure 1

Table 1

Table 3

Conclusion: Patients with OUD-IE were more likely to adhere to treatment if they receive inpatient MAT.