Abstract
BackgroundIn recent years, the number of infective endocarditis (IE) cases associated with injection drug use has increased. Clinical guidelines suggest deferring surgery for IE in people who inject drugs (PWID) due to a concern for worse outcomes in comparison to non-injectors (non-PWID). We performed a systematic review and meta-analysis of long-term outcomes in PWID who underwent cardiac surgery and compared these outcomes to non-PWID.MethodsWe systematically searched for studies reported between 1965 and 2018. We used an algorithm to estimate individual patient data (eIPD) from Kaplan-Meier (KM) curves and combined it with published individual patient data (IPD) to analyze long-term outcomes after cardiac surgery for IE in PWID. Our primary outcome was survival. Secondary outcomes were reoperation and mortality at 30-days, one-, five-, and 10-years. Random effects Cox regression was used for estimating survival.ResultsWe included 27 studies in the systematic review and 19 provided data (KM or IPD) for the meta-analysis. PWID were younger and more likely to have S. aureus than non-PWID. Survival at 30-days, one-, five-, and 10-years was 94.3, 81.0, 62.1, and 56.6% in PWID, respectively; and 96.4, 85.0, 70.3, and 63.4% in non-PWID. PWID had 47% greater hazard of death (HR 1.47, 95% CI, 1.05–2.05) and more than twice the hazard of reoperation (HR 2.37, 95% CI, 1.25–4.50) than non-PWID.ConclusionPWID had shorter survival that non-PWID. Implementing evidence-based interventions and testing new modalities are urgently needed to improve outcomes in PWID after cardiac surgery.
Highlights
In recent years, the number of infective endocarditis (IE) cases associated with injection drug use has increased
In comparison to people who do not inject drugs, people who inject drugs (PWID) with IE are typically younger, and have fewer comorbidities or predisposing heart conditions; but are more likely to have more recurrences of IE, Goodman-Meza et al BMC Infectious Diseases (2019) 19:918 be living with HIV, have right-sided valvular disease, and have Staphylococcus aureus as the etiologic agent [9,10,11,12]
In the mixed effects Cox Proportional Hazards model, the hazard ratio (HR) for PWID was 1.47 compared to non-PWID non-PWID survive significantly longer than PWID after valvular surgery for IE
Summary
The number of infective endocarditis (IE) cases associated with injection drug use has increased. PWID are exposed to a wide variety of infectious diseases via injection practices These infections include HIV, hepatitis B and C viruses, and bacterial and fungal infections. In comparison to people who do not inject drugs (non-PWID), PWID with IE are typically younger, and have fewer comorbidities or predisposing heart conditions; but are more likely to have more recurrences of IE, Goodman-Meza et al BMC Infectious Diseases (2019) 19:918 be living with HIV, have right-sided valvular disease, and have Staphylococcus aureus as the etiologic agent [9,10,11,12]. In the US, the total costs for treating bacterial infections in PWID was over $700 million in 2012 [16]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
