Outcomes in skilled nursing facilities versus other locations in outpatient parenteral antimicrobial therapy among patients with substance use disorders.

Objective: People with substance use disorder (SUD) make up an increasing proportion of patients hospitalized for infections that require outpatient parenteral antimicrobial therapy (OPAT). In many settings, patients with SUD may be unable to receive home-based OPAT, and so stay in the hospital or get discharged to skilled nursing facilities (SNF) for ongoing treatment. Our objective was to compare outcomes, especially engagement in SUD treatment, among patients with SUD who received OPAT in SNF versus other settings.

Design: Retrospective cohort study.

Setting: Two academic medical centers.

Patients: Patients with a history of SUD and discharged on OPAT.

Methods: We used a multivariate logistic regression to determine predictors of outcomes among patients discharged to SNF versus other locations.

Results: Among 350 patients with SUD discharged on OPAT, 285 (81.4%) were discharged to SNF. Hospital readmissions, emergency department visits, infection relapse, catheter complications, and adverse drug events related to OPAT were similar in the two groups. Median length of stay was longer in patients discharged to SNF (16 d vs 12 d, P = .001). Being discharged to a SNF was associated with a lower likelihood of engaging in SUD treatment at 30 days postdischarge (adjusted odds ratio: 0.48, 95% confidence interval: 0.26-0.87).

Conclusions: Patients with SUD requiring OPAT discharged to SNF may have decreased engagement in SUD treatment.