862. Addictions Interventions in Patients Admitted with Injection Drug Use Complicated by Infective Endocarditis
Session: Poster Abstract Session: Bacteremia and Endocarditis
Friday, October 9, 2015
Room: Poster Hall
Posters
  • IDWeek 2015 IDUIE Interventions.pdf (141.0 kB)
  • Background: Patients with infective endocarditis (IE) associated with injection drug use (IDU) often receive significant interventions to address infection including cardiac surgery and long-term intravenous antibiotics. Addiction, however, the predisposition of IE, often remains unaddressed as a part of this care. The objective of this study is to evaluate addictions interventions being offered to patients admitted with IDU complicated by IE (IDU-IE).

    Methods: We performed a retrospective review of patients admitted with IDU-IE from January 1, 2004 through August 31 2014 at a large tertiary care medical center. For initial IDU-IE admissions and all readmissions, demographic information, status of IDU, and addictions interventions data was collected.

    Results: 102 patients were admitted with IDU-IE. The median age at first IDU-IE admission was 34 years (IQR 25.9 – 44.5). 50 patients (49.0%) were subsequently readmitted for any cause. 28 patients had documented active IDU at the time of readmission. 14 patients (13.7%) were readmitted with recurrent IE, 12 of whom had active injection drug use.

    At the initial admission, 86.4% of patients had a social work consult, 23.7% had an addiction consult, and 24.0% had a psychiatry consult. Addiction was mentioned as a problem in the discharge planning in 55.9% of cases.  There was a plan for medication-assisted treatment (MAT) – methadone, buprenorphine, or naltrexone – in 8 (7.8%) patients. Of those, 6 involved continuing previous MAT with pre-established providers, none of which were arranged through the medical center. No individuals received overdose prevention education or naloxone prescription at discharge.

    Of the 102 patients, 26 (25.5%) are deceased. The median time from initial admission to death was 306 days (IQR 118-707). The median age at death was 40.9 years.

    Conclusion: Infective endocarditis is a serious, often fatal, infection affecting young patients who inject drugs. Efforts need to be made to improve interventions to address addiction, the underlying cause of IE in these patients. Specific attention should be paid to provision of medication-assisted treatment and overdose prevention education and naloxone distribution.

    Elana Rosenthal, MD1, Adolf Karchmer, MD, FIDSA2, Jesse Theisen-Toupal, MD3, Roger V Araujo-Castillo, M.D.4 and Christopher Rowley, MD/MPH3, (1)Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, (2)Division of Infectious Diseaes, Beth Israel Deaconess Medical Center, Boston, MA, (3)Beth Israel Deaconess Medical Center, Boston, MA, (4)Department of Medicine, Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA

    Disclosures:

    E. Rosenthal, None

    A. Karchmer, None

    J. Theisen-Toupal, None

    R. V. Araujo-Castillo, None

    C. Rowley, None

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