In:
PLOS Medicine, Public Library of Science (PLoS), Vol. 19, No. 7 ( 2022-7-19), p. e1004049-
Abstract:
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 (adjusted hazard ratio [aHR] 0.63, 95% confidence interval [CI] 0.57 to 0.70). 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 (aHR 0.89, 95% CI 0.84 to 0.96). 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.
Type of Medium:
Online Resource
ISSN:
1549-1676
DOI:
10.1371/journal.pmed.1004049
DOI:
10.1371/journal.pmed.1004049.g001
DOI:
10.1371/journal.pmed.1004049.g002
DOI:
10.1371/journal.pmed.1004049.g003
DOI:
10.1371/journal.pmed.1004049.t001
DOI:
10.1371/journal.pmed.1004049.t002
DOI:
10.1371/journal.pmed.1004049.t003
DOI:
10.1371/journal.pmed.1004049.s001
DOI:
10.1371/journal.pmed.1004049.s002
DOI:
10.1371/journal.pmed.1004049.s003
DOI:
10.1371/journal.pmed.1004049.s004
DOI:
10.1371/journal.pmed.1004049.s005
DOI:
10.1371/journal.pmed.1004049.r001
DOI:
10.1371/journal.pmed.1004049.r002
DOI:
10.1371/journal.pmed.1004049.r003
DOI:
10.1371/journal.pmed.1004049.r004
DOI:
10.1371/journal.pmed.1004049.r005
DOI:
10.1371/journal.pmed.1004049.r006
Language:
English
Publisher:
Public Library of Science (PLoS)
Publication Date:
2022
detail.hit.zdb_id:
2164823-2
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