Like ID fellows everywhere, love a S. aureus bacteremia consult. It’s delicious + . Spent hrs discussing complicated or uncomp? 2, 4, or 6 weeks? Dispense recs and sign off. Leave dc planning to primary team… But what about PWUD vs. non-PWUD? How effective are our recs? 1/8

We looked at 5 yrs of S. aureus bacteremia, endocarditis, vertebral osteo, epidural abscess @ZSFGCare @UCSF, compared outcomes of 963 hospitalizations among persons who use drugs (PWUD) vs. non-PWUD.
@VivekJainMD @pcoffin @StephenieLe11 @jenn_mpd @SDoernberg @MarleneMartinMD

PWUD = 39% of S. aureus hospitalizations. Pts are epidemiologically distinct: younger, healthier, though more likely to be experiencing #homelessness, living with #HIV. How patient-centered are our treatment plans for PEH and PWH? 3/8

Opioid use was common (58%), and >40% of this group not offered MOUD. Not acceptable (and hopefully different in 2021)! However, ½ sample reported methamphetamine use! What are we doing for stimulant use disorders + infections?? Not enough. 4/8

Planned IV tx duration same across groups, but treatment completion only 70% in PWUD vs. ~90% in non-PWUD. Among PWUD, 1 in 4 tx courses ended in pt-directed discharge. What does this say about our hospital caring environment? Or the competing life priorities we often disregard?

In adjusted Cox model, no difference in 1-year mortality but double readmission for infection. MRSA independently associated with infection readmission. My conclusion = PWUD often part of an epidemiologically diff group that should have a better prognosis. 6/8

Our ID standard of care is not effective enough for PWUD. We need to do better creating pt-centered options, particularly for MRSA. Call for ID providers to a) support safe drug use with #harmreduction, b) rec SUD treatment when appropriate, c) get into weeds of dc planning.. 7/8

understand pt’s life priorities and consider creative antibiotic tx options (and keep studying outcomes!)
What else am I missing, brain trust? 8/8

@LauraMarks5 @serotavirus @DrEllenEaton @KinnaThakarar @Raaginizzle @jabarocas @simkimmel @tara_vijayan @Darcy_ID_doc @CarlosdelRio7 @IDDoc1978 @asherjs @AllisonRBond @tdbrothers
Link: https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciab367/6255538?login=true