1117. Infectious Endocarditis and Morbidity: Epidemiological Patterns in the Setting of the Opioid Epidemic
Session: Poster Abstract Session: Clinical Infectious Diseases: Bacteremia and Endocarditis
Friday, October 28, 2016
Room: Poster Hall
Posters
  • Endocarditis_poster_v4.pdf (390.3 kB)
  • Background: The opioid epidemic is widespread, and unsafe injection practices among people who inject drugs (PWID) can lead to complications. In Maine, there has been a perceived surge in infectious endocarditis in the setting of increasing injection drug use (IDU).

    Methods: We performed a retrospective analysis of adult patients with definite or possible infectious endocarditis admitted to a tertiary care center in Portland, Maine between January 1, 2013 and January 1, 2016. Our primary objective was to examine differences in demographics, health characteristics, and health service utilization between PWID and non-injection drug users (non-PWID) with endocarditis. We also examined the association between IDU and morbidity, defined as emergency department visits within 3 months of admission or cardiac surgery. Bivariate and multivariate analyses were performed.

    Results: One-hundred and seven patients were included, of which 42 patients (39.3%) had a history of IDU. Compared to non-PWID, PWID were more likely to be homeless (21.4% vs 1.5%, p=0.001), be on medicaid (56.1 vs 21.7, p<0.001) or uninsured (34.1% vs 1.6%, p<0.001), have a history of incarceration (28.6% vs 1.5%, p<0.001), and lacking a primary care physician (28.6% vs 10.8%, p=0.02). PWID also had a higher prevalence of hepatitis C (73.8% vs 1.5%, p<0.001), mental health conditions (100% vs 29.2%, p<0.001), amphetamine (9.5% vs 0%, p=0.02), cocaine (38.1% vs 1.5%, p<0.001), and alcohol use disorders (33.3% vs 4.5%, p<0.001), other illicit drug use (66.7% vs 7.7%, p<0.001), and had significantly longer length of stays (25.6 days vs 17.1 days, p=0.008). Only 11.9% of the PWID group received medication treatment for addiction (MTA) prior to admission. Only 23.8% were discharged on MTA and 2.6% with a naloxone rescue kit. Injection drug use was not associated with morbidity (0.76, 95% CI 0.20-2.89).

    Conclusion: Our results highlight existing health disparities between PWID and non-PWID with infectious endocarditis. Injection drug use was not associated with morbidity, but these results show the need to deliver comprehensive health services to this marginalized population.

    Kinna Thakarar, DO, MPH1, Kristina Rokas, PharmD, BCPS2, F.L. Lucas, PhD3, Elizabeth Andrews, MPH4, Christina Dematteo, DO5, Deirdre Mooney, MD, MPH6, Spencer Powers, MD5, Jeffrey Rosenblatt, MD6, August Valenti, MD7, Marcella Sorg, PhD8 and Mylan Cohen, MD, MPH9, (1)Infectious Disease, Maine Medical Center/ Tufts University School of Medicine, Portland, ME, (2)Pharmacy, Maine Medical Center, Portland, ME, (3)Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME, (4)InterMed Infectious DIsease, Portland, ME, (5)Maine Medical Center, Portland, ME, (6)Maine Medical Center/Tufts University School of Medicine, Portland, ME, (7)Infectious Disease, Maine Medical Center/Tufts University School of Medicine, Portland, ME, (8)University of Maine, Orono, ME, (9)Maine Medical Cener/Tufts University School of Medicine, Portland, ME

    Disclosures:

    K. Thakarar, None

    K. Rokas, None

    F. L. Lucas, None

    E. Andrews, None

    C. Dematteo, None

    D. Mooney, None

    S. Powers, None

    J. Rosenblatt, None

    A. Valenti, None

    M. Sorg, None

    M. Cohen, 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.