Comparing right- and left sided injection-drug related infective endocarditis

Allan Clarelin,Sigurdur Ragnarsson,Magnus Rasmussen,Lars Olaison

doi:10.1038/s41598-020-80869-y

Abstract

The aim of the study was to compare background characteristics, microbiology and outcome of patients with right-sided and left-sided intravenous drug use (IDU) associated infective endocarditis (IE). A nationwide retrospective study using the Swedish Registry on Infective Endocarditis between 2008 and 2019 was conducted. A total of 586 people with IDU-IE were identified and divided into left-sided (n = 204) and right-sided (n = 382) IE. Descriptive statistics, Cox-regression and Kaplan–Meier survival estimates were used. The mean age of patients in the left-sided group was 46 years compared to 35 years in the right-sided group, p < 0.001. Left-sided IE had a higher proportion of females. Staphylococcus aureus was the causative pathogen in 48% of cases in the left-sided group compared to 88% in the right-sided group. Unadjusted and adjusted long-term survival was better in right-sided IE compared to left-sided IE. Independent predictors of long-term mortality were increasing age, end-stage renal disease, nosocomial infection, brain emboli and left-sided IE. Left-sided IE was common in people with IDU but the proportion of females with left-sided IE was low. S. aureus was twice as common in right-sided IE compared to left-sided IE, and the long-term prognosis of right sided IDU-associated IE was better compared to left-sided IE despite the fact that few were operated.

Highlights

The aim of the study was to compare background characteristics, microbiology and outcome of patients with right-sided and left-sided intravenous drug use (IDU) associated infective endocarditis (IE)
Prosthetic valve endocarditis was more common in left-sided IE, occurring in 15% of the cases, compared to 2.1% in right-sided IE
Emboli to the brain were more common in left-sided IE whereas emboli to the lungs were more common in right-sided IE

Summary

Introduction

The aim of the study was to compare background characteristics, microbiology and outcome of patients with right-sided and left-sided intravenous drug use (IDU) associated infective endocarditis (IE). Unadjusted and adjusted long-term survival was better in right-sided IE compared to left-sided IE. Left-sided IE was common in people with IDU but the proportion of females with left-sided IE was low. S. aureus was twice as common in right-sided IE compared to left-sided IE, and the long-term prognosis of right sided IDUassociated IE was better compared to left-sided IE despite the fact that few were operated. Understanding differences in background characteristics and microbiology may provide a better understanding of the difference in pathophysiology of right-sided and left-sided IDU-associated IE. The main aim of this study was to describe patient characteristics and microbiology in right-sided vs. leftsided IE in people with IDU, to identify determinants of long-term survival in IDU-associated IE patients and to compare long-term survival in patients with right-sided vs. left-sided IDU-associated IE

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