Brothers, Thomas D and Lewer, Dan and Jones, Nicola and Colledge-Frisby, Samantha and Farrell, Michael and Hickman, Matthew and Webster, Duncan and Hayward, Andrew and Degenhardt, Louisa (2022) Opioid agonist treatment and risk of death or rehospitalization following injection drug use-associated bacterial and fungal infections: a cohort study in New South Wales, Australia. PLoS Medicine, 19, (7), e1004049. doi: 10.1371/journal.pmed.
External website: https://journals.plos.org/plosmedicine/article?id=...
BACKGROUND: Injecting-related bacterial and fungal infections are associated with significant morbidity and mortality among people who inject drugs (PWID), and they are increasing in incidence. Following hospitalization with an injecting-related infection, use of opioid agonist treatment (OAT; methadone or buprenorphine) may be associated with reduced risk of death or rehospitalization with an injecting-related infection.
METHODS AND FINDINGS: Data came from the Opioid Agonist Treatment Safety (OATS) study, an administrative linkage cohort including all people in New South Wales, Australia, who accessed OAT between July 1, 2001 and June 28, 2018. Included participants survived a hospitalization with injecting-related infections (i.e., skin and soft-tissue infection, sepsis/bacteremia, endocarditis, osteomyelitis, septic arthritis, or epidural/brain abscess). Outcomes were all-cause death and rehospitalization for injecting-related infections. OAT exposure was classified as time varying by days on or off treatment, following hospital discharge. We used separate Cox proportional hazards models to assess associations between each outcome and OAT exposure. The study included 8,943 participants (mean age 39 years, standard deviation [SD] 11 years; 34% women). The most common infections during participants' index hospitalizations were skin and soft tissue (7,021; 79%), sepsis/bacteremia (1,207; 14%), and endocarditis (431; 5%). During median 6.56 years follow-up, 1,481 (17%) participants died; use of OAT was associated with lower hazard of death. During median 3.41 years follow-up, 3,653 (41%) were rehospitalized for injecting-related infections; use of OAT was associated with lower hazard of these rehospitalizations. Study limitations include the use of routinely collected administrative data, which lacks information on other risk factors for injecting-related infections including injecting practices, injection stimulant use, housing status, and access to harm reduction services (e.g., needle exchange and supervised injecting sites); we also lacked information on OAT medication dosages.
CONCLUSIONS: Following hospitalizations with injection drug use-associated bacterial and fungal infections, use of OAT is associated with lower risks of death and recurrent injecting-related infections among people with opioid use disorder.
G Health and disease > Disease by cause (Aetiology) > Needle (sharing / injecting)
G Health and disease > Disease by cause (Aetiology) > Communicable / infectious disease > Bacterial disease / infection
HJ Treatment or recovery method > Substance disorder treatment method > Substance replacement method (substitution) > Opioid agonist treatment (methadone maintenance / buprenorphine)
J Health care, prevention, harm reduction and treatment > Health related issues > Health information and education > Communicable / infectious disease control
P Demography, epidemiology, and history > Population dynamics > Substance related mortality / death
T Demographic characteristics > Person who injects drugs (Intravenous / injecting)
VA Geographic area > Australia and Oceania > Australia
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