1022. Rising Rates of Injection Drug Use Associated Infective Endocarditis in Virginia with Missed Opportunities for Injection Drug Use Disorder Treatment Referral: A Retrospective Cohort Study
Session: Poster Abstract Session: Bacteremia and Endocarditis
Friday, October 5, 2018
Room: S Poster Hall
Background: Injection drug use disorder (IDD) is a growing public health threat in Virginia, though

there is limited knowledge of related morbidity. The purpose of this study was to describe the temporal,

geographic and clinical trends and characteristics of infective endocarditis associated with IDD (IDD-IE)

and to identify opportunities for better-quality care of people with IDD.

Methods: We reviewed charts for all admissions coded for both IE and drug use disorders at the

University of Virginia Medical Center (UVA) from January 2000 to July 2016. A random sample of 30

admissions coded for IE per year were reviewed to evaluate temporal trends in the proportion of IDD

associated IE cases.

Results: There were a total of 76 patients with IDD-IE during the study period, with a seven fold increase

in cases of IDD-IE from the early 2000s to 2016. The proportion of IE that was IDD-associated increased

by nearly 10% each year (prevalence ratio of IDD per year: 1.09, 95% CI: 1.05-1.14). Patients with IDDIE

had longer hospital stays [median days (interquartile range); IDD-IE, 17 (10-29); non-IDD-IE, 10 (6-

18); p-value = 0.001] with almost twice the cost of admission as those without IDD [median (interquartile

range); IDD-IE, $47,899 ($24,578-78,144); non-IDD-IE, $26,460 ($10,220-60,059); p-value = 0.001]. In

52% of cases there was no documentation of any discussion regarding addiction treatment.

Conclusion: IDD-IE cases are increasing in Virginia leading to higher morbidity and health care costs.

IDD-IE may provide an opportunity for the delivery of IDD treatment, counseling, and harm reduction


Megan Gray, MD, Infectious Diseases, University of Virginia, Charlottesville, VA, Elizabeth Rogawski, PhD, MSPH, University of Virginia, Charlottesville, VA, Michael W. Scheld, MD, FIDSA, University of Virginia School of Medicine, Charlottesville, VA and Rebecca Dillingham, MD, MPH, Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA


M. Gray, None

E. Rogawski, None

M. W. Scheld, None

R. Dillingham, None

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