Abstract
Background An active intravenous substance use disorder is often the primary cause of infectious diseases in this population of users and creates a barrier to successful parenteral antimicrobial management. The dilemma is compounded by dramatically limited resources in small US towns.MethodsThis retrospective review from January 2014 through July 2016 aimed to develop a risk stratification approach to aid rural healthcare providers in determining who among patients with addictive disorders could safely be discharged for outpatient antimicrobial therapy with a peripherally inserted central catheter (PICC).ResultsThe high-risk group had a greater likelihood of noncompliance with antimicrobial therapy completion, as well as subsequent illicit drug use during that time frame, compared with the moderate- and low-risk groups. The low-risk group and most of the moderate-risk group could be safely discharged into the community with PICC lines.ConclusionsKey in the risk stratification proposal was identifying risk behaviors and determining their degree. Such information provides pivotal delineators in developing risk stratification criteria.
Highlights
Guidelines on the management of people with intravenous substance use disorders, in clinical settings of severe systemic infectious diseases (IDs), who require parenteral antimicrobial therapy, are limited
We develop a risk stratification approach similar to approaches used in other disciplines [11,12] to aid rural health care providers in determining which persons with addictive disorders can safely be reviewed for outpatient antimicrobial therapy (OPAT)
An underlying disorder such as intravenous drug use (IVDU) may lead to ID or an ID may occur unrelated to the addiction
Summary
Guidelines on the management of people with intravenous substance use disorders, in clinical settings of severe systemic infectious diseases (IDs), who require parenteral antimicrobial therapy, are limited. How to cite this article Camsari U M, Libertin C (August 18, 2017) Small-Town America’s Despair: Infected Substance Users Needing Outpatient Parenteral Therapy and Risk Stratification. An active use disorder is often the primary cause of the ID and creates an important barrier to the success of the treatment and remission of the ID. Tools are needed to aid providers in identifying who could safely receive outpatient antimicrobial therapy (OPAT) in a clinical setting of intravenous drug use (IVDU) in rural settings. An active intravenous substance use disorder is often the primary cause of infectious diseases in this population of users and creates a barrier to successful parenteral antimicrobial management. The dilemma is compounded by dramatically limited resources in small US towns
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