Abstract
BackgroundPatients with injection drug use (IDU) have increased risk of developing infective endocarditis (IE). Previous studies have reported recurrent IE, increased duration of hospital stay, poor adherence and compliance as well as higher mortality and worse outcomes after surgery in the IDU-IE patient group. Further studies are needed to provide a basis for optimized care and prevention of readmissions in this population. This study aims to describe the clinical characteristics and outcomes among patients with IDU-IE.MethodsData of adults with IDU-IE and non-IDU-IE, treated between 2008 and 2017 at the Karolinska University Hospital in Stockholm were obtained from the Swedish National Registry of Infective Endocarditis. Clinical characteristics, microbiological results, treatment durations, results from echocardiography and in-hospital mortality were compared between the groups.ResultsOf the total 522 patients, 165 (32%) had IDU-IE. Patients with IDU-IE were younger than the patients with non-IDU-IE (mean age IDU-IE: 41.6 years, SD 11.9 years; non-IDU-IE: 64.3 years, SD 16.4 years; P < 0.01). No difference in distribution of gender was observed, 33% were females in both the IDU-IE and the non-IDU-IE group. History of previous IE (IDU-IE: n = 49, 30%; non-IDU-IE: n = 34, 10%; P < 0.01) and vascular phenomena (IDU-IE: n = 101, 61%; non-IDU-IE: n = 120, 34%; P < 0.01) were more common among patients with IDU-IE while prosthetic heart valves (IDU-IE: n = 12, 7%; non-IDU-IE: n = 83, 23%; P < 0.01) and known valvular disease (IDU-IE: n = 3, 2%; non-IDU-IE: n = 78, 22%; P < 0.01) were more common among patients with non-IDU-IE. Aetiology of Staphylococcus aureus (IDU-IE: n = 123, 75%; non-IDU-IE: n = 118, 33%; P < 0.01) as well as tricuspid (IDU-IE: n = 91, 55%; non-IDU-IE: n = 23, 6%; P < 0.01) or pulmonary valve vegetations (IDU-IE: n = 7, 4%; non-IDU-IE: n = 2, 1%; P < 0.01) were more common in the IDU-IE group. The overall incidence of IDU-IE decreased during the study period, while the incidence of definite IE increased (P < 0.01).ConclusionsThis study presents that patients with IDU-IE were younger, less frequently treated with surgery and had higher prevalence of vascular phenomena and history of previous IE, aspects that are important for improved management of this population.
Highlights
Patients with injection drug use (IDU) have increased risk of developing infective endocarditis (IE)
Contrasting, there was an overall decrease in incidence of IDUrelated IE (IDU-IE) registered at the hospital between 2008 and 2017 (P < 0.01), an initial increase between 2008 and 2011 was seen from 0.58 to 1.34 cases per 100,000 adult inhabitants (P < 0.01, Fig. 1), but from 2012 to 2017, there was a decrease in incidence from 1.14 to 0.89 cases per 100,000 adult inhabitants in Stockholm county (P < 0.01, Fig. 1)
S. aureus was the most common aetiology among the patients with IDU-IE, and significantly more common compared with patients with non-IDU-IE
Summary
Patients with injection drug use (IDU) have increased risk of developing infective endocarditis (IE). Infective endocarditis (IE) is one of the infectious diseases with the highest morbidity and mortality [1,2,3,4]. In several countries, such as the United States, the incidences of IE have been reported as increasing [1,2,3,4]. The exposure from injected substances causing endothelial damage has been reported as the mechanism behind the right-sided manifestations, which most often present as tricuspid valve vegetations [3, 6, 7]
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