Title: Current Issues in Patients with Injection Drug Use Associated Infective Endocarditis
Background: Injection drug use (IDU) is a known predisposing factor for infective endocarditis (IE). Much of the literature on IDU associated IE (IDU-IE) is from the 1980s and 1990s. We aimed to provide a more recent description of patients (pts) admitted with IDU-IE.
Methods: We performed a retrospective review of pts admitted with IDU-IE from January 1, 2004 through August 31, 2014 at a large tertiary care medical center. Data was collected regarding demographic information, microbiology, site of infection, complications of IE, cardiothoracic (CT) surgery consultation and intervention, and death.
Results: 102 pts were admitted with IDU-IE, of whom 20 pts had prior episodes of IE. There were 18 subsequent readmissions for recurrent IE in 14 patients.
Of 82 episodes of initial IE, 29(35%) were R sided, 32 (39%) were L sided, and 12(15%) were R and L sided. S. aureus caused IE in 55 (67%) pts. There was hemodynamic (HD) compromise in 27(33%), paravalvular abscess in 14(17%), large vegetation in 50(61%), systemic emboli in 66(80%), unresponsive organism, in 6(7%) and prosthetic valve (PV) dysfunction in 1(1%). CT surgery was consulted in 55(71%) pts and surgery was done in 32(39%).
Of 38 episodes of recurrent IE, 6(16%) were R sided, 23(61%) were L sided, and 4(11%) were R and L sided. S. aureus caused IE in 15(42%). There was HD compromise in 17(45%), paravalvular abscess in 12(32%), large vegetation in 15(39%), systemic emboli in 24(63%), unresponsive organism in 7(18%), and PV dysfunction in 5(13%). CT surgery was consulted in 27(75%) pts and surgery was done in 12(32%).
Of the 102 pts, 26 (25.5%) are deceased. 12/82(15%) died after initial IE and 14/38(37%) died after recurrent IE.
Conclusion: Current pts admitted with IDU-IE present with complicated disease, often manifesting one or more indications for surgical intervention. Many pts experience recurrences of IE, which may be even more complicated and life threatening than initial IE. Optimal management and decisions regarding surgical intervention can be difficult in pts with active IDU. Further evaluation is needed to assess the potential benefit of surgical interventions in pts with IDU-IE, and the role for addiction treatment and harm reduction strategies in preventing recurrent IDU-IE.
R. V. Araujo-Castillo, None
J. Theisen-Toupal, None
C. Rowley, None