Clinical manifestations and outcome in Staphylococcus aureus endocarditis among injection drug users and nonaddicts: a prospective study of 74 patients

Abstract

BackgroundEndocarditis is a common complication in Staphylococcus aureus bacteremia (SAB). We compared risk factors, clinical manifestations, and outcome in a large, prospective cohort of patients with S. aureus endocarditis in injection drug users (IDUs) and in nonaddicts.MethodsFour hundred and thirty consecutive adult patients with SAB were prospectively followed up for 3 months. Definite or possible endocarditis by modified Duke criteria was found in 74 patients: 20 patients were IDUs and 54 nonaddicts.ResultsEndocarditis was more common in SAB among drug abusers (46%) than in nonaddicts (14%) (odds ratio [OR], 5.12; 95% confidence interval [CI], 2.65–9.91; P < 0.001). IDUs were significantly younger (27 ± 15 vs 65 ± 15 years, P < 0.001), had less ultimately or rapidly fatal underlying diseases (0% vs 37%, P < 0.001) or predisposing heart diseases (20% vs 50%, P = 0.03), and their SAB was more often community-acquired (95% vs 39%, P < 0.001). Right-sided endocarditis was observed in 60% of IDUs whereas 93% of nonaddicts had left-sided involvement (P < 0.001). An extracardiac deep infection was found in 85% of IDUs and in 89% of nonaddicts (P = 0.70). Arterial thromboembolic events and severe sepsis were also equally common in both groups. There was no difference in mortality between the groups at 7 days, but at 3 months it was lower among IDUs (10%) compared with nonaddicts (39%) (OR, 5.73; 95% CI, 1.20–27.25; P = 0.02).ConclusionS. aureus endocarditis in IDUs was associated with as high complication rates including extracardiac deep infections, thromboembolic events, or severe sepsis as in nonaddicts. Injection drug abuse in accordance with younger age and lack of underlying diseases were associated with lower mortality, but after adjusting by age and underlying diseases injection drug abuse was not significantly associated with mortality.

Surgical Treatment for Isolated Tricuspid Valve Endocarditis

“…drug abuse is the other most common predisposing factor for TV endocarditis. 9, 21 Patients are usually of young age and present with systemic symptoms of infection. S. aureus is the most common pathogen in these patients.…”

Tricuspid Valve Endocarditis with Septic Pulmonary Emboli in a Drug Addict

“…1,2,5,6) Ruotsalainen et al 7) underlined the increased incidence of infective endocarditis being 46% among IVDA. Additionally, others demonstrated a high infestation rate of methicillin-resistant Staphylococcus aureus (MRSA) in IVDA.…”

Infective endocarditis in patients with hepatic diseases

“…Presenting symptoms (such as chest pain, dyspnea, cough, and hemoptysis, as well as complications of pulmonary infarction, pulmonary abscess, pneumothorax, pleural effusion, and empyema) result from septic emboli to the lungs. Mortality in this subgroup was relatively low; in general, mortality associated with IE in addicts is significantly lower than in non-addicts [16].…”