ArticleThe American journal of medicine2022
Patient-Directed Discharges Among Persons Who Use Drugs Hospitalized with Invasive Staphylococcus aureus Infections: Opportunities for Improvement.
Article in The American journal of medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers.
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Who cites it
19 citing papers in PubMed, 27 citations in OpenAlex.
- Patient-Directed Discharge Among Hospitalized Persons With Opioid Use Disorder in the Fentanyl Era: A Scoping Review.American journal of medicine open · 2026Review
- Improving hospital-based care for patients with injection-drug related infections: provider perspectives.Addiction science & clinical practice · 2026Article
- Long-acting glycopeptides: what are the barriers to access in patients who need them most, and how can they be overcome?The Journal of antimicrobial chemotherapy · 2026Article
- Antibiotic treatment duration for isolated methicillin-susceptibleJAC-antimicrobial resistance · 2025Article
- Bacterial and fungal infections in persons who inject drugs.Clinical microbiology reviews · 2025Review
- Early Results of Implementing Rapid Methadone Titration for Hospitalized Patients: A Case Series.Journal of general internal medicine · 2025Article
- Ethical Management of Challenging Behaviors in Hospitalized People Who Use Drugs.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2025Article
- Harm Reduction in Inpatient Hospital Settings: An Ethics (Principlist) Analysis.Health care analysis : HCA : journal of health philosophy and policy · 2025Article
- Incidence, Patient-Directed Discharge, Readmission, and Mortality Among People Hospitalized With Injecting-Related Infection: A Population-Based Linkage Study.Open forum infectious diseases · 2025Article
- Hospital Security Searches Among Patients With Substance-Related Encounters.JAMA network open · 2025Article
- Real-World Dalbavancin Use for Serious Gram-Positive Infections: Comparing Outcomes Between People Who Use and Do Not Use Drugs.Open forum infectious diseases · 2024Article
- Contemporary Management of Staphylococcus aureus Bacteremia-Controversies in Clinical Practice.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023Review
- Outcomes of Partial Oral Antibiotic Treatment for Complicated Staphylococcus aureus Bacteremia in People Who Inject Drugs.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023Article
- Partial-Oral Antibiotic Therapy for Bone and Joint Infections in People With Recent Injection Drug Use.Open forum infectious diseases · 2023Article
- Article
- Medication Initiation, Patient-directed Discharges, and Hospital Readmissions Before and After Implementing Guidelines for Opioid Withdrawal Management.Journal of addiction medicineArticle
- A descriptive survey evaluating the implementation and outcomes of a training session highlighting concepts in antimicrobial management and harm reduction for hospital-based clinicians treating persons who use drugs.Therapeutic advances in infectious diseaseArticle
- Health care professional perspectives on discharging hospitalized patients with injection drug use-associated infections.Therapeutic advances in infectious diseaseArticle
- Description and outcomes of patients with substance use disorder with serious bacterial infections who had a multidisciplinary care conference.Therapeutic advances in infectious diseaseArticle
Corrections and comments
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Authors and funding
11 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundDespite the high burden of Staphylococcus aureus infections among persons who use drugs, limited data exist comparing outcomes of patient-directed discharge (known as discharge against medical advice) compared with standard discharge among persons who use drugs hospitalized with S. aureus infection.
methodsWe conducted a retrospective study of hospitalizations among adults with S. aureus bacteremia, endocarditis, epidural abscess, or vertebral osteomyelitis at 2 San Francisco hospitals between 2013 and 2018. We compared odds of 1-year readmission for infection persistence or recurrence and 1-year mortality via multivariable logistic regression models adjusting for age, sex, Charlson comorbidity index, and homelessness.
resultsOverall, 80 of 340 (24%) of hospitalizations for invasive S. aureus infections among persons who use drugs involved patient-directed discharge. More than half of patient-directed discharges 41 of 80 (51%) required readmission for persistent or recurrent S. aureus infection compared with 54 of 260 (21%) patients without patient-directed discharge (adjusted odds ratio 3.8, 95% confidence interval [CI] 2.2-6.7). One-year cumulative mortality was 15% after patient-directed discharge compared with 11% after standard discharge (P = .02); however, this difference was not significant after adjustment for mortality risk factors. More than half of deaths in the patient-directed discharge group (7 of 12, 58%) were due to drug overdose; none was due to S. aureus infection.
conclusionsAmong persons who use drugs hospitalized with invasive S. aureus infection, odds of hospital readmission for infection were almost 4-fold higher following patient-directed discharge compared with standard discharge. All-cause 1-year mortality was similarly high in both groups, and drug overdose was a common cause of death in patient-directed discharge group.
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