Oritavancin for the treatment of complicated gram-positive infection in persons who inject drugs
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(2020) 21:73
RESEARCH ARTICLE
Open Access
Oritavancin for the treatment of complicated gram-positive infection in persons who inject drugs Aileen Ahiskali1 and Heather Rhodes2*
Abstract Background: Treatment of complicated infections in persons who inject drugs (PWID) and patients experiencing homelessness poses a unique challenge to clinicians. Long-acting lipoglycopeptide antibiotics, such as oritavancin, may facilitate extended courses of outpatient intravenous therapy while avoiding the need for central lines, improving compliance and thus increasing the chance of clinical cure. Methods: Retrospective chart review of adult PWID who received at least one dose of oritavancin for a gram-positive infection between 1/1/17 and 6/30/19 at a large safety net hospital. Results: Twenty three PWID received 24 courses of at least one dose of oritavancin for a gram-positive infection; 16 were experiencing homelessness at the time of diagnosis. Methicillin resistant Staphylococcus aureus (MRSA) was the most common infecting pathogen and bone or joint the most frequent infection site. Nineteen encounters resulted in clinical cure, including 5 whose conditions improved despite non-adherence to their prescribed regimen. Three patients experienced a non-favorable outcome. Two patients experienced mild adverse drug reactions that did not interfere with therapy; no patients died while on therapy. Conclusion: Oritavancin may be a clinically effective treatment option for the management of complicated gram-positive infections in PWID and patients experiencing homelessness. Further studies should be performed to validate these results.
Introduction Effective strategies to improve serious infection treatment outcomes in non-adherent patients are lacking and complicated by injection drug use (IDU) and homelessness. Up to 70% of persons who inject drugs (PWID) experience at least 1 bacterial skin infection in their lifetime, but it is difficult to accurately describe the true breadth of the problem as a recent study found that more than half of all IDUassociated bacterial infections (ABIs) may be * Correspondence: heather.rhodes@hcmed.org 2 Clinical Quality Improvement, Hennepin Healthcare, Orange 1.220-7, 701 Park Avenue, Minneapolis, MN 55415, USA Full list of author information is available at the end of the article
unrecorded [1–4]. Adding further complexity to treatment, the prevalence of homelessness among PWID has been reported to be as high as 59% [5]. Homelessness significantly increases the risk of relapse in those who have previously stopped injecting, promoting initial and recurrent IDU-ABIs [6]. Complex socioeconomic factors often limit the ability to administer first-line therapies. Outpatient parenteral antibiotic therapy (OPAT) is controversial due to concerns of inappropriate central line access and treatment failure risk [7]. Eaton et al. challenged this apprehension by employing a 9-point risk assessment to successfully administer OPAT to PWID, reducing average length of stay from 42 to 22 days [8].
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