Abstract
BackgroundTreatment of complicated infections in persons who inject drugs (PWID) and patients experiencing homelessness poses a unique challenge to clinicians. Long-acting lipoglycopeptide antibiotics, such as oritavancin, may facilitate extended courses of outpatient intravenous therapy while avoiding the need for central lines, improving compliance and thus increasing the chance of clinical cure.MethodsRetrospective chart review of adult PWID who received at least one dose of oritavancin for a gram-positive infection between 1/1/17 and 6/30/19 at a large safety net hospital.ResultsTwenty three PWID received 24 courses of at least one dose of oritavancin for a gram-positive infection; 16 were experiencing homelessness at the time of diagnosis. Methicillin resistant Staphylococcus aureus (MRSA) was the most common infecting pathogen and bone or joint the most frequent infection site. Nineteen encounters resulted in clinical cure, including 5 whose conditions improved despite non-adherence to their prescribed regimen. Three patients experienced a non-favorable outcome. Two patients experienced mild adverse drug reactions that did not interfere with therapy; no patients died while on therapy.ConclusionOritavancin may be a clinically effective treatment option for the management of complicated gram-positive infections in PWID and patients experiencing homelessness. Further studies should be performed to validate these results.
Highlights
Effective strategies to improve serious infection treatment outcomes in non-adherent patients are lacking and complicated by injection drug use (IDU) and homelessness
All patients in this study were evaluated by an infectious diseases (ID) physician as prescription of ORI is restricted to ID physicians at our institution due to its high drug acquisition cost and broad gram-positive spectrum of activity; pharmacy does not release ORI unless authorized by ID
Thirteen encounters were excluded; the primary reason for exclusion was no known history of injection drug use (n = 9); other reasons included a diagnosis outside of the inclusion criteria (n = 2) and greater than 14 days elapsed between administered doses (n = 2)
Summary
Effective strategies to improve serious infection treatment outcomes in non-adherent patients are lacking and complicated by injection drug use (IDU) and homelessness. Up to 70% of persons who inject drugs (PWID) experience at least 1 bacterial skin infection in their lifetime, but it is difficult to accurately describe the true breadth of the problem as a recent study found that more than half of all IDUassociated bacterial infections (ABIs) may be Complex socioeconomic factors often limit the ability to administer first-line therapies. Outpatient parenteral antibiotic therapy (OPAT) is controversial due to concerns of inappropriate central line access and treatment failure risk [7]. Treatment of complicated infections in persons who inject drugs (PWID) and patients experiencing homelessness poses a unique challenge to clinicians. Long-acting lipoglycopeptide antibiotics, such as oritavancin, may facilitate extended courses of outpatient intravenous therapy while avoiding the need for central lines, improving compliance and increasing the chance of clinical cure
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