The Impact of Inpatient Medication Assisted Treatment in Opioid Use Disorder-Associated Infective Endocarditis: A Retrospective Cohort Study - Abstract
Background: Patients admitted with opioid use disorder-associated infective endocarditis (OUD-IE) often experience opiate withdrawal putting them at risk of leaving prior to completion of IE treatment. Inpatient treatment with medication-assisted treatment (MAT), including buprenorphine or methadone, has the potential to mitigate withdrawal and decrease morbidity and mortality associated with OUD-IE. Methods: In this retrospective cohort study we evaluated outcomes of adults admitted with OUD-IE who received inpatient MAT compared to those who did not receive inpatient MAT. Our primary outcomes were adherence to treatment and leaving against medical advice (AMA). We also evaluated demographics, causative organisms, and complications. Results: There were 49 patients with 89 unique admissions associated with OUD-IE. Mortality rate was high with 11 inpatient deaths (22%). Admissions that resulted in death were excluded from our comparison groups (n=11). Of the 78 evaluable admissions for OUD-IE, 18 (23%) received inpatient MAT. Significantly, 14 of 18 (78%) admissions adhered to treatment when MAT was given, compared to 21 of 60 (35%) when MAT was not given (p=0.001). Furthermore, 4 of 18 (22%) left AMA when MAT was given, compared 39 of 60 (65%) when no MAT was given (p=0.001). Those who received inpatient MAT were more likely to adhere to treatment and less likely to leave AMA (OR=6.5; 95% CI=1.9, 22.27). Conclusions: Patients with OUD-IE are more likely to adhere to treatment when they receive inpatient MAT. MAT should be encouraged for all patients admitted with OUD-IE.