Community-onset bloodstream infection among people with opioid use disorders: a twenty-year population-based cohort study in Queensland, Australia.

Background: Few studies have examined infection risk related to opioid misuse in non-selected populations.

Objectives: We sought to identify clinical factors and outcomes among adults with opioid use disorder-associated bloodstream infections (BSI)in Queensland, Australia.

Methods: All Queensland residents aged ≥20 years with incident community-onset BSI hospitalised within the public healthcare system during 2000-2019 were included. Patients with opioid use disorders were identified and clinical and outcome information obtained using state-wide databases.

Results: 77,392 community-onset BSIs occurred among 66,424 individuals of which 828 (1.3%) patients were diagnosed with an opioid use disorder. Subjects with opioid use disorders were younger and less likely to have healthcare-associated infections. While the prevalence of nearly all co-morbidities evaluated was higher among subjects without opioid use disorders, patients with opioid use disorders were six times more likely to have liver disease. Endocarditis was eight times more likely among subjects with opioid use disorders, and these patients were more likely to be infected with Staphylococcus aureus and/or yeasts, and less likely Escherichia coli as compared to those without opioid use disorders. The median hospital stays were 18 and 8 days and crude all cause 30-day case-fatality was 5.1% versus 11.4% for those with and without opioid use disorders, respectively (p < 0.001 for each). After adjusting for confounding variables, an opioid use disorder was not associated with increased risk for death (adjusted odds ratio; 1.0; 95% confidence interval, 0.7-1.4; p = 0.9).

Conclusion: Opioid use disorders are potentially modifiable conditions that are associated with a major burden of BSI-related disease.