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Suboptimal Addiction Interventions for Patients Hospitalized with Injection Drug Use Associated Infective Endocarditis.
Am J Med. 2015 Nov 17;
Authors: Rosenthal ES, Karchmer AW, Theisen-Toupal J, Castillo RA, Rowley C
Abstract
BACKGROUND: Infective endocarditis is a serious infection often resulting from injection drug use. Inpatient treatment regularly focuses on management of infection without attention to the underlying addiction. We aimed to determine the addiction interventions done in patients hospitalized with injection drug use associated infective endocarditis.
METHODS: This is a retrospective review of patients hospitalized with injection drug use associated infective endocarditis from January, 2004 through August, 2014 at a large academic tertiary care center in Boston, Massachusetts. For the initial and subsequent admissions, data was collected regarding addiction interventions, including consultation by social work, addiction clinical nurse and psychiatry, documentation of addiction in the discharge summary plan, plan for medication-assisted treatment and naloxone provision.
RESULTS: 102 patients were admitted with injection drug use associated infective endocarditis, 50 patients (49.0%) were readmitted and 28 (27.5%) patients had ongoing injection drug use at readmission. At initial admission, 86.4% of patients had social work consultation, 23.7% had addiction consultation, and 24.0% had psychiatry consultation. Addiction was mentioned in 55.9% of discharge summary plans, 7.8% of patients had a plan for medication-assisted treatment, and naloxone was never prescribed. Out of 102 patients, 26 (25.5%) are deceased. The median age at death was 40.9 years (IQR 28.7-48.7).
CONCLUSIONS: We found that patients hospitalized with injection drug use associated infective endocarditis had high rates of readmission, recurrent infective endocarditis and death. Despite this, addictions interventions were suboptimal. Improved addiction interventions are imperative in the treatment of injection drug use associated infective endocarditis.
PMID: 26597670 [PubMed - as supplied by publisher]