A Retrospective Cohort Study of Oral Antimicrobial Therapy Offers in Hospitalized People Who Inject Drugs Who Elect for Self-directed Discharge.

Objectives: To evaluate infection management in people who inject drugs (PWID) who elect for self-directed discharge (SDD) and to identify characteristics associated with an oral antimicrobial therapy offer (OATO).

Methods: This was a retrospective cohort of hospitalized adult PWID with an injection drug use (IDU)-related infection who elected for SDD between January 1, 2014, to January 31, 2024, at a five-hospital health system in southeast Michigan. Patients were excluded if they were hospitalized for <24 hours or if antimicrobial treatment was completed before SDD. The primary outcome was the proportion of patients with an OATO at or before SDD. Secondary outcomes at 30 days included retreatment, infection-related readmission, and all-cause mortality.

Results: One hundred fifty patients were included; 55 (37%) received an OATO, 95 (63%) did not receive an offer. Patient outcomes were not different between the OATO and no offer groups: infection retreatment 19 (34%) versus 32 (34%); infection-related readmission 14 (25%) versus 31 (33%); and all-cause mortality 1 (2%) versus 3 (3%). In multivariable logistic regression, variables independently associated with OATO included prescribing/continuing medications for opioid use disorder (MOUD) (adjusted odds ratio [aOR], 2.8; 95% CI: 1.36-5.92), infection source control (aOR, 2.3; 95% CI: 1.10-4.84), and early-career clinician care (aOR, 2.8; 95% CI: 1.01-7.89).

Conclusions: Most hospitalized PWID with IDU-related infections with SDD did not receive an OATO. Early career clinicians more commonly offered oral antimicrobials in PWID with less complicated infection types. Standardizing OATO in PWID at risk for SDD should be considered as a future direction to improve health outcomes.