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.

Background: People who use drugs (PWUD) are at increased risk for severe infections and face many barriers when completing conventional, typically parenteral antimicrobial treatments. Despite evidence supporting various antibiotic options, such as oral antibiotic therapy, there has been limited uptake of these strategies by many clinicians. Objectives: Create a training for hospital-based clinicians detailing harm reduction and various antimicrobial treatment options for the care of PWUD with severe infections. Examine current hospital-based clinician practices regarding the care of PWUD. Compare pre- and post-training clinician knowledge and comfort around various antibiotic treatment options, harm reduction, and substance use stigma. Design: The study design was a pre- and post-intervention descriptive survey. The intervention was the training session. Surveys were completed by participants before and after the training. Surveys were completed by participants before and after the training and asked about participants' practices and attitudes regarding PWUD and treatment options. Methods: The training was provided to hospital-based clinicians across eight different sites in four different states from November 2022 to November 2023. We examined knowledge, attitudes, and practices around treating injection drug use-associated infections, patients with substance use disorders, and comfort with antimicrobial treatment options using pre-and post-training surveys. We also used a modified version of a validated substance use stigma instrument to measure stigma pre- and post-training. For paired pre-post survey data, we used McNemar's test to compare Likert scale responses. Results: Of 167 study participants, 126 (75%) completed the pretraining survey, and 42 (25%) provided paired pre-post survey responses. Among the 126 pre-survey respondents, 64 (51%) were trainees, 75 (60%) frequently treated patients with injection drug use-associated infections, and 61 (50%) reported consistently applying harm reduction strategies to these patients in the hospital. Post-training, participants with paired data were significantly more likely to agree with applying harm reduction principles to the care of PWUD (pre, 23 (55%); post, 39 (95); Conclusion: Our study shows that an interactive training for hospital-based clinicians can significantly improve clinician knowledge and comfort with applying harm reduction strategies and with offering various antibiotic treatment options to PWUD with severe infections.