39 - Comparative One-year Outcomes of Invasive staphylococcus Aureus infections Among Persons with and Without Drug Use in an Urban West Coast Cohort

Background: Persons who use drugs (PWUD) face substantial risk from invasive Staphylococcus aureus infections but have important demographic and clinical differences from persons without drug use (non-PWUD). Despite this, limited data exist comparing S. aureus infection outcomes in PWUD vs. non-PWUD; these data are needed to inform interventions to optimize care for this vulnerable population.

Methods: We identified adults hospitalized from 2013-2018 at two academic hospitals in San Francisco with S. aureus bacteremia or ICD-coded diagnoses of endocarditis, epidural abscess, or vertebral osteomyelitis with compatible S. aureus culture. Via structured chart review, we compared the following among PWUD vs. non-PWUD: clinical and substance use features, adjusted odds of antibiotic completion, and one-year infection-free survival using a multivariate Cox proportional hazards model adjusted for age/race, housing, comorbidities, and MRSA.

Results: Of 963 hospitalizations for invasive S. aureus infections in 946 patients, 372/963 (39%) occurred in PWUD. Among PWUD, heroin (198/372, 53%) and methamphetamine use (185/372, 50%) were common (Table 1). Bacteremia occurred in 82% of hospitalizations. PWUD vs. non-PWUD had higher proportions of MRSA (48% vs. 31%) and invasive infections: 20% vs. 12% with endocarditis, 25% vs. 11% with epidural abscess, and 28% vs. 13% with vertebral osteomyelitis (all p< 0.001). PWUD had more self-directed (“AMA”) discharges, and most using opioids did not receive methadone or buprenorphine (Table 2). PWUD completed antibiotic courses less often (70% vs. 87%; p< 0.001) and had 2.9-fold higher adjusted odds of incomplete treatment (95% CI:1.7-5.0). One-year mortality was lower in PWUD (18% vs. 30%), but one-year readmission for ongoing/recurrent infection was far higher (28% vs. 14%; HR 1.9 [95% CI:1.3-2.9], Figure 1).Table 1: Demographic, Clinical, and Substance Use Characteristics
Table 2: Care Delivery, PWUD vs. non-PWUD
Figure 1: One-year Infection-free survival in persons who use drugs (PWUD) vs. non-PWUD


Conclusion: PWUD had higher proportions of S. aureus vertebral osteomyelitis, epidural abscess, and endocarditis than non-PWUD, lower odds of treatment completion, and greater risk of infection persistence/recurrence at one year. Among PWUD, opioid and stimulant use were common and undertreated. New patient centered models of care that deliver synchronized S. aureus infection and substance use disorder therapy are urgently needed.

Presenting Author(s)

• 

  Ayesha Ashley Appa, MD

  Fellow
  UCSF/ZSFG Infectious Diseases
  San Francisco, CA

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

  Slides Slides and Audio

Co-Author(s)

• MA

  Meredith Adamo, MD

  Resident Physician
  UCSF
  San Francisco, California

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

  Stephenie Le, MD

  Resident Physician
  UCSF
  San Francisco, California

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

  Jennifer Davis, MD

  Resident Physician
  UCSF
  San Francisco, California

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

  Lisa Gail Winston, MD

  Professor
  University of California, San Francisco
  San Francisco, California

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

  Sarah B. Doernberg, MD, MAS

  Associate Professor
  University of California, San Francisco
  San Francisco, California

  Disclosure: Basilea : Advisor or Review Panel member (Status: Ongoing), Consultant (Status: Ongoing); Genentech () : Consultant
• 

  Henry Chambers, B.A., MD

  Professor of Medicine, Emeritus
  UC San Francisco School of Medicine
  San Francisco, CA

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

  Marlene Martin, MD

  Assistant Clinical Professor, Medicine
  UCSF
  San Francisco, California

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

  Phillip Coffin, MD, MIA

  Director of the Center on Substance Use and Health
  San Francisco Department of Public Health
  San Francisco, California

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

  Vivek Jain, MD, MAS

  Associate Professor
  Division of HIV, Infectious Diseases & Global Medicine San Francisco General Hospital University of California, San Francisco
  San Francisco, California

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