1283. Long Term Outcomes of Valve Surgery in the Treatment of Infective Endocarditis within the Injection Drug Use Population
Session: Poster Abstract Session: Bacteremia and Endocarditis
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • IDWeek 2013 Poster.pdf (805.2 kB)
  • Background:  There is limited data showing long term outcomes of injection drug users (IDUs) undergoing valve replacement or repair for the treatment of infective endocarditis (IE). Although IDU may be an independent predictor of mortality, it is unclear whether this is related to immediate post operative complications or subsequent re-infection or re-admission.

    Methods: Demographics and surgical data of consecutive adults who underwent valve surgery for IE were prospectively collected between January 2003 and July 2012 at our institution. Retrospective chart review was conducted, and semiparametric tests were used to determine the outcomes of all cause mortality, rate of re-infection, re-admission and re-operation.

    Results: A total of 195 patients underwent valve surgery, of which 24 were identified as IDUs. IDUs had a lower mean age (39.4 vs. 59.1, p<0.0001) and body mass index (23.6 vs. 26.6, p=0.007) when compared to non-IDUs. IDUs were less likely to have hypertension (p<0.0001) and coronary artery disease (p=0.03), and more likely to have tricuspid (p=0.001) and pulmonic valve (p=0.02) involvement. No difference was observed in the initial length of hospital stay (p=0.95) or post-operative need for dialysis (p=0.40). IDU was associated with increased mortality (HR 2.79, 95% Confidence Interval [CI] 1.11 to 7.04; p=0.029), re-infection (HR 7.84, 95% CI 2.56 to 24.0; p<0.0001) and re-admission (HR 7.29, 95% CI 3.29 to 16.2; p<0.0001). Upon adjustment for co-variates, IDU was still associated with increased mortality (HR 4.38 95% CI 1.40 to 13.8, p=0.011). Although not statistically significant, there was a trend toward a higher rate of re-operation (HR 1.88 CI 0.77 to 4.58; p=0.17).

    Conclusion: IDU was a predictor of mortality, re-infection and re-admission to hospital. This is despite the fact that IDUs are younger with less hypertension and coronary artery disease. In addition, there was no difference in initial post-operative complications as indicated by length of hospital stay and need for dialysis. The management of IE among IDUs is challenging and efforts to improve long term outcomes require a focus on prevention of re-infection through multi-disciplinary interventions.

    Ivan Ying, MD1, Vincent Chan, MD MPH2, Fraser Rubens, MD MS2 and Mark Tyndall, MD ScD1, (1)Division of Infectious Diseases, University of Ottawa, Ottawa, ON, Canada, (2)Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON, Canada

    Disclosures:

    I. Ying, None

    V. Chan, None

    F. Rubens, None

    M. Tyndall, None

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