{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T07:33:34Z","timestamp":1777880014738,"version":"3.51.4"},"reference-count":27,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2023,1,1]],"date-time":"2023-01-01T00:00:00Z","timestamp":1672531200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["UL1TR002544"],"award-info":[{"award-number":["UL1TR002544"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Therapeutic Advances in Infection"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>People who inject drugs (PWID) are at risk for severe bacterial and fungal infections including skin and soft tissue infections, endocarditis, and osteomyelitis. PWID have high rates of self-directed discharge and are often not offered outpatient antimicrobial therapies, despite studies showing their efficacy and safety in PWID. This study fills a gap in knowledge of patient and community partner perspectives on treatment and discharge decision making for injection drug use (IDU)-associated infections.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We conducted semi-structured interviews with patients ( n\u2009=\u200910) hospitalized with IDU-associated infections and community partners ( n\u2009=\u20096) in the Portland, Maine region. Community partners include peer support workers at syringe services programs (SSPs) and outreach specialists working with PWID. We transcribed and thematically analyzed interviews to explore perspectives on three domains: perspectives on long-term hospitalization, outpatient treatment options, and patient involvement in decision making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Participants noted that stigma and inadequate pain management created poor hospitalization experiences that contributed to self-directed discharge. On the other hand, patients reported hospitalization provided opportunities to connect to substance use disorder (SUD) treatment and protect them from outside substance use triggers. Many patients expressed interest in outpatient antimicrobial treatment options conditional upon perceived efficacy of the treatment, perceived ability to complete treatment, and available resources and social support. Finally, both patients and community partners emphasized the importance of autonomy and inclusion in medical decision making. Although some participants acknowledged their SUD, withdrawal symptoms, or undertreated pain might interfere with decision making, they felt these medical conditions were not justification for health care professionals withholding treatment options. They recommended open communication to build trust and reduce harms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Patients with IDU-associated infections desire autonomy, respect, and patient-centered care from healthcare workers, and may self-discharge when needs or preferences are not met. Involving patients in treatment decisions and offering outpatient antimicrobial options may result in better outcomes. However, patient involvement in decision making may be complicated by many contextual factors unique to each patient, suggesting a need for shared decision making to meet the needs of hospitalized patients with IDU-associated infections.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/20499361231197065","type":"journal-article","created":{"date-parts":[[2023,9,8]],"date-time":"2023-09-08T03:51:47Z","timestamp":1694145107000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":5,"title":["\u201cI know my body better than anyone else\u201d: a qualitative study of perspectives of people with lived experience on antimicrobial treatment decisions for injection drug use-associated infections"],"prefix":"10.1177","volume":"10","author":[{"given":"Amy","family":"Eckland","sequence":"first","affiliation":[{"name":"Tufts University School of Medicine, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Kohut","sequence":"additional","affiliation":[{"name":"Maine Health Institute for Research, Center for Interdisciplinary Population and Health Research, Portland, ME, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Henry","family":"Stoddard","sequence":"additional","affiliation":[{"name":"Maine Health Institute for Research, Center for Interdisciplinary Population and Health Research, Portland, ME, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deb","family":"Burris","sequence":"additional","affiliation":[{"name":"Maine Health Institute for Research, Center for Interdisciplinary Population and Health Research, Portland, ME, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank","family":"Chessa","sequence":"additional","affiliation":[{"name":"Tufts University School of Medicine, Boston, MA, USA"},{"name":"Maine Medical Center, Portland, ME, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8192-8019","authenticated-orcid":false,"given":"Monica K.","family":"Sikka","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Oregon Health & Science University, Portland, OR, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel A.","family":"Solomon","sequence":"additional","affiliation":[{"name":"Division of Infectious Disease, Brigham and Women\u2019s Hospital, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Colleen M.","family":"Kershaw","sequence":"additional","affiliation":[{"name":"Section of Infectious Disease and International Health, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA"},{"name":"Geisel School of Medicine at Dartmouth, Hanover, NH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ellen F.","family":"Eaton","sequence":"additional","affiliation":[{"name":"Division of Infectious Disease, University of Alabama, Birmingham, AL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebecca","family":"Hutchinson","sequence":"additional","affiliation":[{"name":"Tufts University School of Medicine, Boston, MA, USA"},{"name":"Maine Health Institute for Research, Center for Interdisciplinary Population and Health Research, Portland, ME, USA"},{"name":"Maine Medical Center, Portland, ME, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter D.","family":"Friedmann","sequence":"additional","affiliation":[{"name":"Office of Research, Baystate Health and UMass Chan Medical School\u2014Baystate, Springfield, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas J.","family":"Stopka","sequence":"additional","affiliation":[{"name":"Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathleen M.","family":"Fairfield","sequence":"additional","affiliation":[{"name":"Tufts University School of Medicine, Boston, MA, USA"},{"name":"Maine Health Institute for Research, Center for Interdisciplinary Population and Health Research, Portland, ME, USA"},{"name":"Maine Medical Center, South Portland, ME, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4689-0240","authenticated-orcid":false,"given":"Kinna","family":"Thakarar","sequence":"additional","affiliation":[{"name":"Maine Medical Center, 41 Donald B. Dean Drive, Suite B, South Portland, ME 04106, USA"},{"name":"Tufts University School of Medicine, Boston MA, USA"},{"name":"Maine Health Institute for Research, Center for Interdisciplinary Population and Health Research, Portland, ME, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2023,9,8]]},"reference":[{"key":"bibr1-20499361231197065","doi-asserted-by":"publisher","DOI":"10.1016\/j.mcna.2021.08.006"},{"key":"bibr2-20499361231197065","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.10.082"},{"key":"bibr3-20499361231197065","volume":"73","author":"Barocas JA","year":"2020","journal-title":"Clin Infect Dis"},{"key":"bibr4-20499361231197065","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2014.01.010"},{"key":"bibr5-20499361231197065","doi-asserted-by":"publisher","DOI":"10.1080\/08897077.2019.1671942"},{"key":"bibr6-20499361231197065","unstructured":"Harm Reduction Coalition. Principles of harm reduction, https:\/\/harmreduction.org\/about-us\/principles-of-harm-reduction\/ (2020, accessed 1 September 2023)."},{"key":"bibr7-20499361231197065","doi-asserted-by":"publisher","DOI":"10.1016\/j.mcna.2021.09.002"},{"key":"bibr8-20499361231197065","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciy722"},{"key":"bibr9-20499361231197065","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciac714"},{"key":"bibr10-20499361231197065","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofab633"},{"key":"bibr11-20499361231197065","unstructured":"Medical Respite. Boston health care for the homeless program. https:\/\/www.bhchp.org\/services\/medical-respite\/(accessed 13 July 2023)."},{"key":"bibr12-20499361231197065","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofy194"},{"key":"bibr13-20499361231197065","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2022.03.349"},{"key":"bibr14-20499361231197065","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofac364"},{"key":"bibr15-20499361231197065","volume-title":"Association for multidisciplinary education and research in substance use and addiction national conference","author":"Moore N"},{"key":"bibr16-20499361231197065","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0145817"},{"key":"bibr17-20499361231197065","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-021-06514-9"},{"key":"bibr18-20499361231197065","unstructured":"Our Programs. Amistad. https:\/\/amistadmaine.org\/ (2023, accessed 13 July 2023)."},{"key":"bibr19-20499361231197065","unstructured":"Syringe Service Programs. Maine department of health and human services. https:\/\/www.maine.gov\/dhhs\/mecdc\/infectious-disease\/hiv-std\/services\/syringe-service-programs.shtml (2023, accessed 15 February 2023)."},{"key":"bibr20-20499361231197065","unstructured":"MAXQDA 2022. VERBI Software. Updated 2021. maxqda.com"},{"key":"bibr21-20499361231197065","doi-asserted-by":"publisher","DOI":"10.1191\/1478088706qp063oa"},{"key":"bibr22-20499361231197065","doi-asserted-by":"publisher","DOI":"10.1111\/add.13314"},{"key":"bibr23-20499361231197065","doi-asserted-by":"publisher","DOI":"10.1177\/1049732315588501"},{"key":"bibr24-20499361231197065","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2015.08.018"},{"key":"bibr25-20499361231197065","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2021.103438"},{"key":"bibr26-20499361231197065","doi-asserted-by":"publisher","DOI":"10.1056\/EVIDccon2100012"},{"key":"bibr27-20499361231197065","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.191365"}],"container-title":["Therapeutic Advances in Infectious Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/20499361231197065","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/20499361231197065","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/20499361231197065","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T23:59:45Z","timestamp":1777593585000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/20499361231197065"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1]]},"references-count":27,"alternative-id":["10.1177\/20499361231197065"],"URL":"https:\/\/doi.org\/10.1177\/20499361231197065","relation":{},"ISSN":["2049-9361","2049-937X"],"issn-type":[{"value":"2049-9361","type":"print"},{"value":"2049-937X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1]]},"article-number":"20499361231197065"}}