Screening for co-infections in patients with substance use disorders and severe bacterial infections.

BACKGROUND

Patients with substance use disorders admitted for severe bacterial infection are in a prime position to be screened for important co-infections. However, data suggest that standard screening for co-infections in this population during hospital admission can vary in frequency and type of testing.

METHODS

We performed a retrospective review of patients to evaluate screening for co-infections during admission, followed by a case-control analysis to determine factors associated with lack of any screening.

RESULTS

We identified 280 patients with 320 eligible admissions. Most were male and Caucasian with unstable housing. Only 67 (23.9%) patients had a primary-care provider. About 89% (n = 250) of our cohort were screened for one or more co-infection during their first admission with one patient never screened despite subsequent admissions. Of those screened, the greatest proportion was HIV (219, 81.4% of those without history of HIV), HCV (94, 79.7% of those without a prior positive HCV antibody), syphilis (206, 73.6%), gonorrhea, and chlamydia (47, 16.8%) with new positive tests identified in 60 (21.4%) people. Screening for all five co-infections was only completed in 15 (14.0%) of the 107 patients who had screening indications. Overall, a high proportion of those screened had a new positive test, including three cases of neurosyphilis, highlighting the importance of screening and treatment initiation. One patient was prescribed HIV pre-exposure prophylaxis at discharge and only 37 (34.6%) of those eligible were referred for HCV treatment or follow-up. In multivariable case-control analysis, non-Medicaid insurance (OR 2.8, 95% CI: 1.2-6.6, p = 0.02), use of only 1 substance (OR 2.9, 95% CI: 1.3-6.5, p < 0.01), and no documented screening recommendations by the infectious disease team (OR 3.7, 95% CI: 1.5-8.8, p < 0.01), were statistically significantly associated with lack of screening for any co-infection during hospital admission.

CONCLUSION

Our data suggest additional interventions are needed to improve inpatient screening for co-infections in this population.