1381. Infectious Disease Complications in Hospitalized Patients with Opioid Use Disorder at a Southern County Hospital

Abstract

Abstract Background Injection drug-use (IDU) has increased over the past two decades and contributes towards the morbidity and mortality of opioid use disorder (OUD). Recent studies of IDU-associated infections have primarily focused on regions outside of the southern United States; however, this area presents greater barriers to healthcare funding and harm reduction services for patients with OUD seeking care. This study aims to describe the burden of IDU-associated infections amongst patients with OUD referred to addiction psychiatry at a southern county hospital. Methods A retrospective electronic health record review was conducted for patients admitted to a large urban county hospital from February 2018 to December 2019. Inclusion criteria included active OUD within the last 12 months and an addiction psychiatry consultation. Frequency of baseline patient characteristics were compared between those with and without IDU-associated infections, and IDU-associated infections were characterized. Additionally, medication for opioid use disorder (MOUD) uptake was described. Results 260 charts were reviewed, and 229 individuals met inclusion criteria. 36% were female, 47% non-Hispanic white, and 36% Hispanic. 62% reported IDU in the past 30 days. 45% had IDU-associated infections, with skin and soft-tissue infections (SSTI) being most common (77%), followed by bacteremia (23%), osteomyelitis, (13%), and endocarditis (9%). Comorbid stimulant use disorder was also prevalent (72%). Patients with IDU-associated infections were uninsured at higher rates (79% vs. 60%). 48% of patients with IDU-associated infections had monomicrobial infections, and 23% had polymicrobial infections. While patients with no IDU-associated infections had higher rates of active MOUD on admission (28% vs. 10%), new MOUD uptake was higher among patients with IDU-associated infections (80% vs. 53%). Abbreviations: OUD, opioid use disorder; IDU, injection drug-use; COPD, chronic obstructive pulmonary disease; HTN, hypertension; CHF, congestive heart failure; Hep, hepatitis; HIV, human immunodeficiency virus Abbreviations: OUD, opioid use disorder; IDU, injection drug-use; SSTI, skin and soft tissue infection; Hep, hepatitis; HIV, human immunodeficiency virus; ID, infectious diseases Abbreviations: IDU, injection drug-use Conclusion These findings indicate that SSTIs compose most IDU-associated infections in hospitalized patients with OUD, which may reflect greater black tar heroin availability in the southern United States. Furthermore, increased rates of MOUD uptake amongst those with IDU-associated infections support the notion that hospitalization can be an effective circumstance in which to initiate substance use treatment. Disclosures Ank E. Nijhawan, MD, MPH, MSCS, Gilead Sciences: Grant/Research Support.