Outcomes of Orthopaedic Infections in Recreational Intravenous Drug Users Requiring Long-term Antibiotic Treatment

Patients who participate in recreational injection drug use (RIVDU) have an increased risk of orthopaedic infections requiring prolonged treatment with intravenous antibiotics. This study reviews clinical outcomes and complications in RIVDU and have orthopaedic infections requiring long term antibiotic therapy (>4 weeks) and compares these outcomes to non-RIVDU patients. In this retrospective review, patients were divided into cohorts based on RIVDU history; the RIVDU cohort was further divided into subcohorts based on treatment location. Cohorts and subcohorts were compared to evaluate clinical outcomes. Between the two main cohorts, there was a statistically significant difference in treatment compliance (P = 0.0012) and no statistically significant differences for infection resolution at 6- or 12-month follow-up, hospital readmission, or mortality. At the 6-month follow-up, RIVDU patients who remained inpatient had 100% resolution of infection, which was significantly better than the resolution of all other cohorts (P = 0.0019). No differences were observed between the remaining subcohorts for resolution of infection by 12 months, catheter complications, or loss to follow-up. Our findings demonstrate an increased rate of failure in outpatient parenteral antibiotic therapy in RIVDU patients, and this population has better clinical outcomes when they remain inpatient for the duration of treatment.