buprenorphine and Bacterial-Infections

Patients with opioid use disorder (OUD) are frequently admitted for invasive infections. Medications for OUD (MOUD) may improve outcomes in hospitalized patients.. In this retrospective cohort of 220 admissions to a tertiary care center for invasive infections due to OUD, we compared 4 MOUD treatment strategies: methadone, buprenorphine, methadone taper for detoxification, and no medication to determine whether there were differences in parenteral antibiotic completion and readmission rates.. The MOUDs were associated with increased completion of parenteral antimicrobial therapy (64.08% vs 46.15%; odds ratio [OR] = 2.08; 95% CI, 1.23-3.61). On multivariate analysis, use of MOUD maintenance with either buprenorphine (OR = 0.38; 95% CI, .17-.85) or methadone maintenance (OR = 0.43; 95% CI, .20-.94) and continuation of MOUD on discharge (OR = 0.35; 95% CI, .18-.67) was associated with lower 90-day readmissions. In contrast, use of methadone for detoxification followed by tapering of the medication without continuation on discharge was not associated with decreased readmissions (OR = 1.87; 95% CI, .62-5.10).. Long-term MOUDs, regardless of selection, are an integral component of care in patients hospitalized with OUD-related infections. Patients with OUD should have arrangements made for MOUDs to be continued after discharge, and MOUDs should not be discontinued before discharge.

Topics: Adult; Aged; Anti-Bacterial Agents; Antifungal Agents; Bacterial Infections; Buprenorphine; Continuity of Patient Care; Drug Users; Female; Humans; Invasive Fungal Infections; Male; Medication Adherence; Methadone; Middle Aged; Opiate Substitution Treatment; Opioid-Related Disorders; Patient Readmission; Retrospective Studies; Substance Abuse, Intravenous; Tertiary Care Centers; Time Factors; Treatment Outcome; Young Adult

Misuse of high-dose buprenorphine (HDB), mainly by injection, is responsible of frequent infectious adverse events.. This is a retrospective study of infectious complications occurring in patients using HDB by injection. Forty-two cases were identified (29 men and ten women) and the data were collected between March 1999 and December 2008.. The infectious complications included cutaneous infections (27 cases), endocarditis (nine cases), osteoarticular infections (four spondylodiscitis and one sacroiliitis), and a vascular embolism with decrease in visual acuity.. The results of HDB maintenance treatment must be improved, both from the point of view of substitution and to limit its misuse by intravenous route injection. Health professionals have to play an important role in drug addict patients' education and supervision, to prevent buprenorphine injection and related infectious complications.

Topics: Abscess; Adult; Bacterial Infections; Buprenorphine; Discitis; Dose-Response Relationship, Drug; Endocarditis, Bacterial; Female; Heroin Dependence; Humans; Injections, Intravenous; Injections, Subcutaneous; Male; Narcotic Antagonists; Retrospective Studies