1115. Comparing Sentinel Admission for Infective Endocarditis Among Patients With and Without Injection Drug Use: A Single Center Study
Session: Poster Abstract Session: Clinical Infectious Diseases: Bacteremia and Endocarditis
Friday, October 28, 2016
Room: Poster Hall
  • Leahey - ID Week IE.pdf (447.0 kB)
  • Background: Injection drug use (IDU) is a risk factor for infective endocarditis (IE). This study describes the differences in IDU-associated IE (IDU-IE) compared to non-IDU IE with the goal of informing clinical management as we face a national opioid epidemic.

    Methods: We performed a retrospective review of patients with a primary admission for IE at a large tertiary care center from January 1, 2007 to June 30, 2015. Patients who met the modified Duke’s criteria for definite IE were included and stratified by IDU status. Information was collected regarding demographics, microbiology, site of infection, IE complications, cardiothoracic (CT) surgery intervention, and death.

    Results: 381 patients were admitted with definite IE, of whom 103 (27%) had IDU-IE. The mean age in patients with IDU-IE was 35.4 years (33.3-37.4) vs 61.9 years (60.1-63.8) in non-IDU (p<0.001). Patients with IDU-IE had more prior IE (22[21.4%] vs 18[6.5%], p=0.003). Patients with IDU-IE had significantly less diabetes, renal dysfunction, and prior cardiac surgery.

    IDU-IE was more commonly caused by Staphylococcus aureus (67[65%] vs 97[34.8%], p<0.001, Figures). IDU-IE vs non-IDU IE was more frequently right-sided (35.0% vs 5.4%), more likely to involve both the left and right sides (9.7% vs 2.5%);rates of prosthetic valve involvement were similar (8.7% vs 16.2%).

    IDU-IE was more associated with vegetation > 1cm (61[59.2%] vs 84[30.2%], p<0.001), systemic emboli (85[82.5%] vs 135[48.6%], p=0.04), and resistant organisms (8[7.8%] vs 8[2.9%], p<0.001). There was no difference in rates of hemodynamic compromise, perivalvular abscess, prosthetic valve dysfunction, or antibiotic failure. Among cases of IDU-IE, CT surgery was consulted in 74 (71.8%) vs 155 (55.8%), p=0.01) and surgery performed in 40 (38.8%) vs 79 (28.4%, p=0.06).

    The 1-year mortality in IDU-IE was 16(15.5%) compared to 37(13.3%) in non-IDU IE (p=0.62).

    Conclusion: Despite significantly younger age, fewer medical comorbidities and fewer prior cardiac surgeries, 1-year mortality was similar for patients with IDU-IE and non-IDU IE. Further investigation is warranted to elucidate the impact of IDU on management of IE and whether additional interventions can improve clinical outcomes.

    P. Alexander Leahey, MD, Infectious Diseases, BIDMC, Boston, MA, Mary Lasalvia, MD, MPH, Medicine, Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, Elana Rosenthal, MD, Division of Infectious Diseases; Institute of Human Virology, University of Maryland, Bathesda, MD, Adolf Karchmer, MD, FIDSA, Division of Infectious Diseaes, Beth Israel Deaconess Medical Center, Boston, MA and Christopher Rowley, MD/MPH, Beth Israel Deaconess Medical Center, Boston, MA


    P. A. Leahey, None

    M. Lasalvia, None

    E. Rosenthal, None

    A. Karchmer, None

    C. Rowley, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.