PMID- 35853024 OWN - NLM STAT- MEDLINE DCOM- 20220721 LR - 20230415 IS - 1549-1676 (Electronic) IS - 1549-1277 (Print) IS - 1549-1277 (Linking) VI - 19 IP - 7 DP - 2022 Jul TI - 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. PG - e1004049 LID - 10.1371/journal.pmed.1004049 [doi] LID - e1004049 AB - 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 (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. FAU - Brothers, Thomas D AU - Brothers TD AUID- ORCID: 0000-0002-5570-5556 AD - National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Sydney, Australia. AD - UCL Collaborative Centre for Inclusion Health, Institute of Epidemiology and Health Care, University College London, London, United Kingdom. AD - Department of Medicine, Dalhousie University, Halifax, Canada. FAU - Lewer, Dan AU - Lewer D AUID- ORCID: 0000-0003-3698-7196 AD - National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Sydney, Australia. AD - UCL Collaborative Centre for Inclusion Health, Institute of Epidemiology and Health Care, University College London, London, United Kingdom. FAU - Jones, Nicola AU - Jones N AUID- ORCID: 0000-0002-5742-4598 AD - National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Sydney, Australia. FAU - Colledge-Frisby, Samantha AU - Colledge-Frisby S AUID- ORCID: 0000-0003-3571-0136 AD - National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Sydney, Australia. FAU - Farrell, Michael AU - Farrell M AUID- ORCID: 0000-0001-7008-8130 AD - National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Sydney, Australia. FAU - Hickman, Matthew AU - Hickman M AUID- ORCID: 0000-0001-9864-459X AD - Population Health Sciences, University of Bristol, Bristol, United Kingdom. FAU - Webster, Duncan AU - Webster D AD - Department of Medicine, Dalhousie University, Halifax, Canada. AD - Division of Infectious Diseases, Saint John Regional Hospital, Saint John, Canada. FAU - Hayward, Andrew AU - Hayward A AUID- ORCID: 0000-0002-3549-6232 AD - UCL Collaborative Centre for Inclusion Health, Institute of Epidemiology and Health Care, University College London, London, United Kingdom. FAU - Degenhardt, Louisa AU - Degenhardt L AUID- ORCID: 0000-0002-8513-2218 AD - National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Sydney, Australia. LA - eng GR - R25 DA013582/DA/NIDA NIH HHS/United States GR - DRF-2018-11-ST2-016/DH_/Department of Health/United Kingdom GR - R25 DA033211/DA/NIDA NIH HHS/United States GR - MR/N00616X/1/MRC_/Medical Research Council/United Kingdom GR - FRN 171259/CIHR/Canada PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20220719 PL - United States TA - PLoS Med JT - PLoS medicine JID - 101231360 RN - 0 (Analgesics, Opioid) SB - IM MH - Adult MH - Analgesics, Opioid/adverse effects MH - Australia MH - *Bacteremia MH - Cohort Studies MH - *Endocarditis/chemically induced/complications/drug therapy MH - Female MH - Humans MH - Male MH - *Mycoses/chemically induced/drug therapy/epidemiology MH - New South Wales/epidemiology MH - Opiate Substitution Treatment MH - *Sepsis/drug therapy/epidemiology MH - *Substance Abuse, Intravenous/complications/drug therapy/epidemiology PMC - PMC9295981 COIS- I have read the journal's policy and the authors of this manuscript have the following competing interests: In the past 3 years, LD and MF have received untied educational grant funding from Indivior and Seqirus. LD is a member of the Editorial Board of PLOS Medicine. EDAT- 2022/07/20 06:00 MHDA- 2022/07/22 06:00 PMCR- 2022/07/19 CRDT- 2022/07/19 13:34 PHST- 2022/02/12 00:00 [received] PHST- 2022/06/12 00:00 [accepted] PHST- 2022/07/19 13:34 [entrez] PHST- 2022/07/20 06:00 [pubmed] PHST- 2022/07/22 06:00 [medline] PHST- 2022/07/19 00:00 [pmc-release] AID - PMEDICINE-D-22-00493 [pii] AID - 10.1371/journal.pmed.1004049 [doi] PST - epublish SO - PLoS Med. 2022 Jul 19;19(7):e1004049. doi: 10.1371/journal.pmed.1004049. eCollection 2022 Jul.