1024. First Episode Infective Endocarditis in Persons Who Inject Drugs (PWIDs); a retrospective cohort study
Session: Poster Abstract Session: Bacteremia and Endocarditis
Friday, October 5, 2018
Room: S Poster Hall
Posters
  • poster ID WEEK_Rodger et al1.pdf (950.5 kB)
  • Background: Persons who inject drugs (PWID) represent a distinct demographic of patients with infective endocarditis (IE). Many centers do not perform valvular surgery on these patients due to concerns about poor outcomes.

    Methods: Retrospective cohort study comparing PWID patients to non-PWID patients presenting between February 2007-March 2016 in London, Ontario among adult (>18) inpatients with first episode IE.

    Results: In 370 first episode IE cases, 53.9% occurred in PWIDs. PWID patients were younger (35.4 SD 10.0 vs 59.4 SD 14.9) (p<0.001), more likely to have right-sided infection [125/202 (62%), vs 16/168 (9.5%)(p<0.001)], and more often due to S.aureus (156/202 (77.3%) vs 54/168 (32.1%), p<0.001). Myocardial and aortic root abscesses were less common in PWIDs [17/202 (8.4%) vs 50/168 (30%)(p<0.01)]. There was no difference in the frequency of non-cardiac complications. In total, 36.5% of patients were treated surgically with PWID patients less likely to undergo surgery [39/202 (19.3%) vs 98/168 (58%) p<0.001]. Cox regression analysis identified the protective effect of cardiac surgery with regards to survival in all patients, with a hazard ratio of 0.49 (95% CI 0.31-0.76, p<0.001), as well as among PWIDs (HR 0.39, 95% CI 0.17-0.87, p=0.02). Among all patients, lower survival was associated with older age (HR 1.03, 95% CI 1.00-1.05 , p<0.001), injection drug use (HR 2.72, 95% CI 1.52-4.88, p<0.001), left sided infection (HR 3.48, 95% CI 2.01-6.03, p<0.001), and bilateral infection (HR 3.19, 95% CI 1.45-7.01, p=0.004). The lower survival of left-sided infection (HR 4.01, 95% CI 1.97-8.18, p<0.001) or bilateral infection (HR 6.94, 95%CI 2.39-20.2,p<0.001) was re-demonstrated in PWIDs.

    Conclusion: This study identifies important clinical differences between PWIDs and non-drug users with respect to valve involvement, causative organism, complications and management strategies. Our results highlight the important role of surgical treatment in a carefully selected PWID patient population.

    Laura Rodger, MD1, Dresden GlockerLauf, MPH1, Esfandiar Shojaei, MD1, Adeel Sherazi, MD2, Brian Hallam, BA1, Laura Ball, BSc, MPH2, Sharon Koivu, MD2, Kaveri Gupta, MD, FRCP1, Seyed Hosseini-Moghaddam, MD3 and Michael Silverman, MD, FRCP, FACP4, (1)Schulich School of Medicine and Dentistry, London, ON, Canada, (2)Western University, London, ON, Canada, (3)Medicine, Western University, London, ON, Canada, (4)Infectious Diseases, St. Joseph's Health Care and London Health Sciences Centre, London, ON, Canada

    Disclosures:

    L. Rodger, None

    D. GlockerLauf, None

    E. Shojaei, None

    A. Sherazi, None

    B. Hallam, None

    L. Ball, None

    S. Koivu, None

    K. Gupta, None

    S. Hosseini-Moghaddam, None

    M. Silverman, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.