Infectious Disease Complications Associated with Opioid Use Disorder at a Southern County Hospital: A Retrospective Chart Review

Abstract Background: Injection drug-use (IDU) is related to significant morbidity and mortality. Recent studies of IDU-associated infections have primarily focused on regions outside of the southern US; however, this area presents greater barriers to healthcare funding and lower availability of harm reduction services such as syringe exchange programs.Methods: A retrospective electronic health record review was conducted for patients admitted to an urban county hospital from February 2018-February 2020. Inclusion criteria: (a) opioid use disorder (OUD) within the last 12 months and (b) addiction psychiatry consultation. Baseline characteristics were compared between those with and without IDU-associated infections. IDU-associated infections, cultured microbes, and medication for opioid use disorder (MOUD) uptake were described.Results: Of 283 charts reviewed, 248 individuals met inclusion criteria. 65% were male, 48% non-Hispanic white, and 34% Hispanic. 72% reported opiate IDU in the past 30 days. 52% had IDU-associated infections, including skin and soft-tissue infections (SSTI) (49%), bacteremia (17%), osteomyelitis, (7%), and endocarditis (5%). Comorbid stimulant use disorder was frequently reported (70%). Overall, methicillin-resistant Staphylococcus aureus was the most common organism identified (24%). 40% of IDU-associated infections were monomicrobial, 23% were polymicrobial (including anaerobes, gram-negatives, and yeast species). Those with IDU-associated infections had lower rates of MOUD on admission (8% vs. 32%), but had higher new MOUD uptake (81% vs. 51%).Conclusions: SSTIs, which were often polymicrobial, comprised most IDU-associated infections among inpatients with OUD hospitalized in an urban Texas hospital. Individuals with IDU-associated infections had increased MOUD uptake. These findings have implications for empiric antibiotic management of IDU-associated infections and support inpatient initiation of substance use treatment.