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Objectives To identify the incidence, characteristics, and factors associated with against medical advice (AMA) discharge among hospitalized patients with opioid use disorder (OUD) and injection related infections (eg, endocarditis, osteomyelitis, epidural abscesses). Methods This retrospective cohort study evaluated adults with OUD admitted to an academic medical center from January 1, 2016 to January 7, 2019 for an invasive injection related infection. Multivariable logistic regression was used to determine independent factors associated with AMA discharge. Results Among 262 adults admitted with serious injection related infections and comorbid OUD, 138 received inpatient medications for opioid use disorder (MOUD). Univariate analysis showed a decreased odds ratio (OR) of AMA discharge when patients received MOUD inpatient (OR 0.55; 95% CI 0.34-0.91.). Adjusting for covariates associated with social determinants of health and other substance use, inpatient receipt of MOUD was associated with a decreased risk of AMA discharge (adjusted OR 0.49; 95% CI 0.028-0.84). Conclusions Among patients with OUD and serious injection related infections, inpatient initiation of MOUD is associated with decreased risk of AMA discharge.

Personal protective equipment (PPE) has been an invaluable yet limited resource when it comes to protecting healthcare workers against infection during the 2019 coronavirus (COVID-19) pandemic. In the US, N95 respirator supply chains are severely strained and conservation strategies are needed. A multidisciplinary team at the Washington University School of Medicine, Barnes Jewish Hospital, and BJC Healthcare was formed to implement a program to disinfect N95 respirators. The process described extends the life of N95 respirators using vaporized hydrogen peroxide (VHP) disinfection and allows healthcare workers to retain their own N95 respirator across a large metropolitan healthcare system.

BACKGROUND Rates of sexually transmitted diseases (STDs) including chlamydia and gonorrhea are increasing in the United States while public health funding for STD services is decreasing. Individuals seek care in various locations including the emergency department (ED). The objective of this study is to investigate whether there are more physically proximal clinic-based STD care locations available to individuals who present to the ED in a major metropolitan area. METHODS Addresses of EDs, clinics, and patients 13 years or older in St. Louis City or County given a nucleic acid amplification test and assigned an STD diagnosis (n = 6100) were geocoded. R was used to analyze clinics within 5 radii from the patients' home address and assess missed clinic opportunities (open, no charge, with walk-in availability) for those living in an urban versus suburban area. RESULTS In urban areas, 99.1% of individuals lived closer to a clinic than the ED where they sought STD services; in suburban areas, 82.2% lived closer to a clinic than the ED where they presented. In the region, 50.6% lived closer to the health department-based STD care location than the hospital where they presented. Up to a third of ED patient visits for STD care could have occurred at a clinic that was closer to the patient's home address, open, no charge, and available for walk-in appointments. CONCLUSIONS Clinic availability is present for most of the individuals in our study. Clinics providing STD services can increase advertising efforts to increase public awareness of the services which they provide.

Few antibiotic options exist for the management of infections due to vancomycin-resistant enterococci (VRE). We describe a case involving the safe and successful use of tedizolid, a new oxazolidinone, to treat VRE prosthetic joint infection.