1026. Trends in Infective Endocarditis During the Substance Use Disorder Epidemic at an Academic Medical Center

Abstract

BackgroundIn many areas of the United States, substance use disorders (SUD) have increased dramatically over the past decade. Overdose deaths have increased as well, and Kentucky ranks among the nation’s leaders in deaths per 100,000 population. Infective endocarditis (IE) is a well-known complication of intravenous drug use, contributing to significant morbidity and mortality, but few studies have evaluated the effect of the current SUD epidemic on rates and demographics of IE. We sought to examine the trends in IE and IE with SUD at our institution.MethodsWe collected data from patients admitted to a large academic medical center in Kentucky between January 1, 2013 and December 31, 2016. Patients were classified according to the International Classification of Diseases, Tenth Revision. Patients were considered to have IE if they received codes I33 or I38. Patients were considered to have an SUD if they received codes F11.10, F15.10, F14.10, F19.10, or Z86.59. Data were collected through the TriNetX database (TriNetX, Cambridge, MA).ResultsThere were 2,100 cases of IE during the study period. The mean (SD) age was 53 years (21). Of those, 440 also had an SUD. The mean (SD) age of these patients was 41 years (11). Patients in both the IE and IE/SUD categories were primarily male (54% and 55%) and white (94% and 94%). The number of cases of IE increased from 190 in 2013 to 430 in 2016 (R2 = 0.9877). The number of IE cases diagnosed as having an SUD increased from 30 (16% of all IE cases) in 2013 to 130 (30% of all IE cases) in 2016 (R2 = 0.7352 for the trend). This increase in cases corresponds to a 333% increase in the number of cases of IE with SUD.ConclusionBetween 2014 and 2016, opioid overdose deaths in Kentucky rose from 24.7 to 33.5 per 100,000 population, a 35.6% increase. During a similar timeframe, the number of IE cases associated with SUD at our institution rose 333%. While it is possible that increased coding of substance use disorders factored into this dramatic increase, it appears that the number of IE cases associated with SUD is rising at a disproportionately rapid rate.Disclosures All authors: No reported disclosures.

Epidemiology, Microbiology, and Clinical Outcomes Among Patients With Intravenous Drug Use-Associated Infective Endocarditis in New Brunswick

“… 3 IVDU carries an increased risk of serious medical complications, including infective endocarditis (IE). 4 It has been reported as a risk factor in approximately 10.0% 5 to 60.0% 6 of IE cases, and rising incidence of IVDU-associated infective endocarditis (IVDU-IE) has been described in Ontario, 7 , 8 North Carolina, 6 , 9 Virginia, 10 Kentucky, 11 national US data, 12 , 13 , 14 , 15 and national UK data. 16 There is an urgent need to better understand the characteristics and care needs of this population.…”

Long-Acting Lipoglycopeptides: “Lineless Antibiotics” for Serious Infections in Persons Who Use Drugs

“…An added consideration with oral therapy is that a majority of studied regimens include concurrent rifampin administration, which poses significant risks for drug interactions with both illicit substances abused and the medications used to manage SUD. Novel long-acting IV lipoglycopeptides (laLGP), such as dalbavancin [16, 17] and oritavancin [18, 19], appear to present a unique opportunity for the treatment of complicated bacteremia and other deep-seated infections due to susceptible Gram-positive organisms, which appear more prevalent in persons who use drugs (PWUD) [20]. These agents (1) have potent in vitro activity against a broad array of Gram-positive pathogens, (2) are well tolerated with few significant side effects or medication interactions, and (3) offer built-in treatment adherence owed to their extremely long half-life.…”