Predictors of non-adherence among patients with infectious complications of substance use who are discharged on parenteral antimicrobial therapy


 
 
 The management of invasive infections related to substance use disorder (SUD) needing parenteral antimicrobial therapy is challenging and may have poor infection outcomes including non-adherence and lack of completion of parenteral antimicrobial therapy.
 
 
 
 In this retrospective cohort of 201 patients with invasive infections related to SUD, we looked at frequency and determinants of unfavorable outcomes including non-adherence.
 
 
 
 79% of patients with SUD related infection completed parenteral antibiotic therapy in skilled nursing facilities (SNF). 21.5% of patient episodes had documentation of non-adherence. Non-adherence was higher in patients with active injection drug use (IDU) [28.5% vs 15% in non IDU, adjusted odds ratio (OR) 2.36, 95% CI 1.1-5.5 P = 0.024], patients with active SUD in the prior year (24.5% vs 11%, P = 0.047), patients with use of more than one illicit substance (30.3% vs 17%, P = 0.031), as well as in people experiencing homelessness (32.8% vs 15.7% in stably housed P = 0.005). In a multivariate model, nonadherence was significantly associated with IDU (OR 2.38, 95% CI 1.03-5.5), and homelessness (OR 2.25, 95% CI 1.01-4.8) Medication for opioid use disorder (MOUD) was prescribed at discharge in 68% of overall cohort and was not associated with improved outcomes for any of the above groups.
 
 
 
 Non-adherence to parenteral antimicrobial therapy is high in the most vulnerable patients with unstable high-risk SUD and adverse social determinants of health.
 The design of the work has been approved by Institutional Review Board at the University of Maryland and was deemed exempt from full review and not requiring separate patient consent for purposes of this study.
