A Proposal for Addiction and Infectious Diseases Specialist Collaboration to Improve Care for Patients With Opioid Use Disorder and Injection Drug Use-Associated Infective Endocarditis

Patients with injection drug use-associated infective endocarditis and opioid use disorder often receive treatment for the infection that fails to address its underlying cause. People who inject drugs (PWID) and develop serious infections also face disparities in antibiotic management, particularly with regards to use of outpatient parenteral antimicrobial therapy (OPAT). We highlight literature on OPAT in PWID challenging the notion that PWID cannot be managed with OPAT. Given that OPAT use amongst PWID and non-PWID yields similar outcomes, we argue that a bias against OPAT use in PWID is unwarranted and may reflect stigma rather than data. We further note the proven value of comprehensive OUD treatment on endocarditis treatment outcomes, which also addresses the potential safety concerns of OPAT in PWID, and propose a treatment model in which Addiction and Infectious Disease specialists collaborate to integrate opioid use disorder treatment into injection drug use-associated infective endocarditis care.

Automated summary

Patients with injection drug use-associated infective endocarditis and opioid use disorder often receive inadequate treatment that fails to address the underlying cause. Bias against outpatient parenteral antimicrobial therapy (OPAT) in people who inject drugs (PWID) may reflect stigma rather than data, as OPAT use in PWID yields similar outcomes as in non-PWID. Comprehensive opioid use disorder treatment can improve endocarditis treatment outcomes and address safety concerns of OPAT in PWID. Collaboration between Addiction and Infectious Disease specialists is proposed to integrate opioid use disorder treatment into care for injection drug use-associated infective endocarditis.