Complications of opioid use disorder in hospitalized patients with serious infections: A retrospective analysis of clinical course and outcomes.

Abstract

Background: Opioid use disorder (OUD) poses significant public health threats at epidemic levels in the United States. Injection drug use (IDU) is particularly associated with serious infections, leading to increased risk for complications and poor outcomes. This study aims to characterize the complications and outcomes among patients with OUD who are hospitalized for the management of various infections. Additionally, a comparison of outcomes was performed between the group of patients with OUD who do not inject drugs (non-PWID) and the group of persons who inject drugs (PWID).

Methods: We performed a retrospective chart review using data obtained via the hospital electronic medical record. The study population included adults with inpatient hospitalizations at Westchester Medical Center and Mid-Hudson Regional Hospital, with International Classification of Diseases, Tenth Revision codes for opioid dependence, OUD, and infections from December 2020 to December 2021. The sample size included 51 patients. Statistical analysis was performed to assess outcomes such as length of stay (LOS), complications during hospitalization, and duration of antibiotic use.

Results: Among the 51 patients who met the inclusion criteria, 26 (51.0 percent) had a history of IDU, 20 (39.2 percent) had opioid dependence but did not inject drugs, and five (9.8 percent) were patients with unspecified OUD diagnosis. Of the 26 patients in the PWID group, 16 (61.5 percent) experienced complications during their hospitalization compared to three out of 20 (15 percent) in the non-PWID group (p = 0.002). Complications included either metastatic spread of infection or a requirement for surgical intervention. The mean age in the PWID group was 39.9 years compared to 56.7 years in the non-PWID group (p < 0.001). Mean LOS for PWID was 10.35 days, compared to 9.25 days in the other group (p = 0.708). The mean duration of antimicrobial therapy was longer in the PWID group, 21.32 days compared to 13.68 days in the non-PWID group (p = 0.010).

Conclusions: PWID were younger, more likely to experience complications during their hospitalization, and required a longer duration of antibiotics compared to those who have OUD but do not inject drugs. Infection-related hospitalization of patients with OUD represents an opportunity to provide addiction treatment, counseling, and harm reduction strategies.