{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T15:51:03Z","timestamp":1791993063941,"version":"4.4.0"},"reference-count":0,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Antibiotic strategies for drug use-associated infective endocarditis (DUA-IE) are evolving, but data are limited regarding antibiotic access after patient-directed discharge (PDD). We examined antibiotic fill patterns and 30-day readmission among DUA-IE patients with and without PDD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using national Medicaid data (2016\u20132022), we identified adults aged 18\u201364 with new DUA-IE episodes. We measured antibiotic fill rates among patients discharged to non-facility settings. We used a landmark design, requiring readmission-free survival for 3 days after discharge to observe antibiotic fills. We used multivariable logistic regression to assess associations between PDD and antibiotic fill with 30-day readmission, overall and stratified by PDD status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 19,808 patients included, 5,519 (27.9%) left via PDD. Compared with non-PDD patients, PDD patients were younger, had fewer comorbidities, and had more polysubstance use. Only 17.1% of PDD patients had an antibiotic fill within 3 days versus 44.2% of non-PDD patients (adjusted odds ratio [aOR] 0.25; 95% CI, 0.20\u20130.33). PDD was associated with increased readmission (aOR 1.91; 95%CI, 1.65\u20132.21), while antibiotic fill was associated with reduced readmission (aOR 0.45; 95%CI, 0.40\u20130.50). In stratified analyses, antibiotic fill was associated with a larger magnitude of readmission reduction among PDD patients (aOR 0.27; 95%CI, 0.21\u20130.34) than among non-PDD patients (aOR 0.50; 95%CI, 0.46\u20130.55; p for interaction &amp;lt;.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These findings highlight the need for proactive strategies that ensure treatment continuity including planning for potential PDD, bedside medication delivery, and expanded use of oral and long-acting intravenous antibiotics.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciag649","type":"journal-article","created":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T11:50:27Z","timestamp":1791633027000},"source":"Crossref","is-referenced-by-count":0,"title":["Outpatient Antibiotic Fills and 30-Day Readmission Following Patient-Directed Discharge in Drug Use-Associated Infective Endocarditis in a National Medicaid Cohort"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4680-8032","authenticated-orcid":false,"given":"Fiona","family":"Gispen","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine , New York, NY ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6671-3474","authenticated-orcid":false,"given":"Jialin","family":"Mao","sequence":"additional","affiliation":[{"name":"Department of Population Health Sciences, Weill Cornell Medicine , New York, NY ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3016-0308","authenticated-orcid":false,"given":"Kenneth","family":"Karan","sequence":"additional","affiliation":[{"name":"Department of Population Health Sciences, Weill Cornell Medicine , New York, NY ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3825-4327","authenticated-orcid":false,"given":"Yuhua","family":"Bao","sequence":"additional","affiliation":[{"name":"Department of Population Health Sciences, Weill Cornell Medicine , New York, NY ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4919-7492","authenticated-orcid":false,"given":"Ximena A","family":"Levander","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine and Geriatrics, Addiction Medicine Section, Oregon Health & Science University , Portland, OR ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5036-318X","authenticated-orcid":false,"given":"Elaine","family":"Wethington","sequence":"additional","affiliation":[{"name":"Department of Psychology and Department of Sociology, Cornell University , Ithaca, NY ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2846-9762","authenticated-orcid":false,"given":"Benjamin J","family":"Eckhardt","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, NYU Grossman School of Medicine , New York, NY ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3914-011X","authenticated-orcid":false,"given":"Brianna","family":"Sustersic","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine and Geriatrics, Addiction Medicine Section, Oregon Health & Science University , Portland, OR ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6363-2839","authenticated-orcid":false,"given":"Shashi N","family":"Kapadia","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine , New York, NY ,","place":["USA"]},{"name":"Department of Population Health Sciences, Weill Cornell Medicine , New York, NY ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,10,14]]},"container-title":["Clinical Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/cid\/advance-article-pdf\/doi\/10.1093\/cid\/ciag649\/71947181\/ciag649.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/cid\/advance-article-pdf\/doi\/10.1093\/cid\/ciag649\/71947181\/ciag649.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T15:31:59Z","timestamp":1791991919000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/cid\/advance-article\/doi\/10.1093\/cid\/ciag649\/8916476"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,14]]},"references-count":0,"URL":"https:\/\/doi.org\/10.1093\/cid\/ciag649","relation":{},"ISSN":["1058-4838","1537-6591"],"issn-type":[{"value":"1058-4838","type":"print"},{"value":"1537-6591","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,14]]},"article-number":"ciag649"}}