
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.

K. Thakarar,
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
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