40 - The Impact of Medically Assisted Therapy for Opiate Use Disorder in staphylococcus Aureus Bacteremia Patients Within a Large Hospital System - A Retrospective Cohort Study

Background: Intravenous drug use (IVDU) is a risk factor for development of S. aureus bacteremia (SAB) and prevalent in opiate use disorder (OUD).  While the standard of care involves treating the underlying OUD with medically assisted therapy (MAT), it is unknown how much impact this has on clinical endpoints.

Methods: We conducted a retrospective cohort study of patients with IVDU with hospitalizations for SAB during a 28-month period from 9/2016 through 12/2018 in 10 urban and rural North Carolina hospitals in a single large health system. We compared outcomes for patients receiving prescription for MAT at discharge versus no MAT at discharge.  MAT was defined as receiving methadone, buprenorphine, or naltrexone.  Patients who expired inpatient were excluded from analysis. Clinical endpoints were 30- and 90-day mortality and 30-day SAB-related readmissions.

Results: Of the 174 patients, 28% received a prescription for MAT at discharge.  The majority of the patients were Caucasian (88%), female (57%), with mean age of 37 years. Factors that significantly increased likelihood of MAT at discharge were female gender (34% vs 20%, p=0.04), having a complicated SAB (33% vs 28%, p=0.01), presence of a spinal/epidural abscess (57% vs 43%, p=0.002), and increased length of stay (LOS) (37 days vs 24 days, p=< 0.001). No difference in 30- and 90-day mortality was observed; only one patient in each group died within 90 days. Prescription for any MAT at discharge was associated with a significant decrease in the risk of SAB-related 30-day readmission (0% vs 17%, p=0.002).Table 1: Baseline Characteristics
Table 2: MAT & Clinical Outcomes in S. aureus Bacteremia
Figure1: Medically Assisted Therapy Prescribed at Discharge


Conclusion: Gender, more complicated infections, and prolonged LOS may increase the likelihood of receiving a prescription for MAT at discharge.  MAT prescription at discharge may decrease the risk of 30-day SAB related readmission (NNT 5.9). The results suggest that provision of MAT to patients with SAB and history of IVDU should be incorporated into standardized treatment guidelines.

Presenting Author(s)

• 

  Brooks A. Keene, MD, MS

  Resident Physician
  Atrium Health Carolinas Medical Center
  Charlotte, North Carolina

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

  Slides Slides and Audio

Co-Author(s)

• SS

  Shadi Saboori, MD, MPH

  Resident Physician
  Atrium Health Carolinas Medical Center
  Charlotte, North Carolina

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• JM

  Jacqueline Meredith, PharmD, BCPS, BCIDP

  Clinical Pharmacist, Infectious Diseases and Antimicrobial Stewardship
  Atrium Health, Carolinas Medical Center
  Charlotte, North Carolina

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• DK

  Deanna King, MD, MS

  Resident Physician
  Atrium Health Carolinas Medical Center
  Charlotte, North Carolina

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• CP

  Christopher Polk, MD

  Assistant Professor
  Atrium Health
  Charlotte, North Carolina

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• ML

  Michael Leonard, MD

  Professor
  Atrium Health
  Charlotte, North Carolina

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.