474. Battling Addiction: Impact of Intravenous Drug Use on Invasive Skin and Soft Tissue Management

BACKGROUND: Although skin and soft-tissue infections (SSTIs) remain a common cause of hospitalization for intravenous drug users (IVDU), little has been done to identify whether there should be differences in the SSTI management of IVDU vs. nonusers. The objective of this study was to evaluate the impact of documented intravenous drug abuse on the overall management of invasive SSTIs in hospitalized patients. METHODS: This retrospective cohort study randomly selected 100 IVDU and 100 nonusers (controls) hospitalized for an SSTI over 18 months in a community teaching hospital. Patients eligible for inclusion were 18–60 years old and treated with IV inpatient antibiotics for at least 48 hours. Pregnant women, transfers from an outside hospital, and diabetic foot infections were excluded. The primary endpoint was hospital length of stay (LOS). Secondary endpoints included: percentage prescribed empiric combination antibiotic therapy, percentage prescribed an anti-pseudomonal agent, inpatient and total antibiotic duration of therapy (DOT), 30-day readmission rates, and 30-day emergency department (ED) visit rates. RESULTS: The study population was predominantly male (66%), Caucasian (72%), and had a mean age of 40 years old (18–59). IVDU were more likely to have complications (18% vs. 6%) and polymicrobial infections (19% vs. 2%), Mean hospital length of stay was 9.0 days for IVDU compared with 4.8 days for controls (P < 0.001). There was no difference in empiric combination therapy (48% vs. 37%; P = 0.115) or empiric exposure to an anti-pseudomonal agent (38% vs. 30%; P = 0.232). Mean duration of inpatient antibiotic DOT was longer in IVDU (7.5 days vs. 4.3 days; P < 0.001), but total antibiotic DOT was similar between groups (16.0 days vs. 13.8 days; P = 0.141). Thirty-day ED visits were higher for IVDU (16% vs. 5%; P = 0.009); however, there was no difference in 30-day readmission (14% vs. 16%; P = 0.692). CONCLUSION: Documented IV drug abuse resulted in a significant increase in the length of stay in hospitalized adults with SSTIs requiring IV antibiotics. Exposure to combination therapy and anti-pseudomonal agents did not differ between the groups as would be expected. In the future stewardship initiatives are needed to increase adherence to SSTI guideline recommendations for empiric therapy. DISCLOSURES: All authors: No reported disclosures.