Infective endocarditis in intravenous drug users: a review article

Colville, Thomas; Sharma, Vishal; Albouaini, Khaled

doi:10.1136/postgradmedj-2015-133648

Cited by 38 publications

(51 citation statements)

References 27 publications

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“…To our knowledge, this is the largest study (n=33) showcasing detailed survey data regarding injection practices of PWID with IE. Previous studies suggested that IE in PWID was more frequently seen in males, younger patients and those with concurrent HIV infections (3,8,9). Our results show similar age distribution of IE, with it occurring in younger individuals (mean age 34).…”

Section: Discussionsupporting

confidence: 84%

“…This infectious complication of intravenous drug use (IVDU) is associated with significant morbidity and mortality requiring extensive and costly(1,2) multidisciplinary care (7). PWID are at risk of IE due to: comorbidities of HIV, hepatitis C and skin and soft tissue infections; non-sterile injection practices; and the reuse of injection drug preparation equipment (IDPE) (2,4,(8)(9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

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Risk Factors Of Infective Endocarditis In Persons Who Inject Drugs

Shah

Wong

Ball

et al. 2020

Preprint

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Background: The rising incidence of infective endocarditis (IE) among people who inject drugs (PWID) has been a major concern across North America. Details of injection practices leading to IE are not well characterized.Methods: A case-control study, using one-on-one interviews to understand risk factors and injection practices associated with IE among PWID was conducted. Eligible participants included those who had injected drugs within the last 3 months, were > 18 years old and either never had or were currently admitted for an IE episode. Cases were recruited from the tertiary care centers and controls were recruited from outpatient clinics in patients without IE and addiction clinics in London, Ontario. Results: 33 cases (PWID IE+) and 102 controls (PWID but IE-) were interviewed. Using clean injection equipment from the provincial distribution network was a protective factor against IE (p<0.001). Furthermore, using lighters during the injection process was also protective for IE (OR 2.5; 95% CI 1.11–5.63). Female sex (OR 3.63; 95% CI 1.58-8.36) and injection into multiple sites (OR 4.31; 95% CI 1.33-13.93) were associated with IE. Injection into the feet (57.6% cases; 36.6% control; p= 0.034) was also associated with IE. Discussion: Our pilot study highlights the importance of distributing clean injection materials for IE prevention. Injection into multiple areas may indicate a greater difficulty in accessing common and safer injection sites such as the arm, and thus multi-site injections may be a surrogate marker for injection-related venous damage in entrenched drug users. Moreover, the use of lighters may be correlated with the best practice of heating preparations of drugs prior to injection, which is known to reduce bacterial burden. Lastly, gender differences in injection techniques, which may place women at higher risk of IE, requires further study.

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Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Risk Factors Of Infective Endocarditis In Persons Who Inject Drugs

Shah

Wong

Ball

et al. 2020

Preprint

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“…Deep tissue infections (DIT) are pathogenic infections involving subcutaneous tissues that may proliferate to surrounding tissues and muscles [1]. This is particularly due to the introduction of bacteria into the venous circulation or subcutaneous tissue, which is common among those who inject drugs [2,3]. Multiple studies have indicated increasing rates of infective endocarditis [4][5][6][7], osteomyelitis [3,[8][9][10][11][12][13][14][15], and septic arthritis associated with intravenous drug use.…”

Section: Introductionmentioning

confidence: 99%

A retrospective cohort study evaluating correlates of deep tissue infections among patients enrolled in opioid agonist treatment using administrative data in Ontario, Canada

et al. 2020

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The objective of this study was to evaluate the relationship between individual characteristics and deep tissue infections in patients enrolled in opioid agonist treatment in Ontario, Canada. Methods A retrospective cohort study was conducted on patients in opioid agonist treatment between January 1, 2011, and December 31, 2015 in Ontario, Canada. Patients were identified using data from the Ontario Health Insurance Plan Database, and the Ontario Drug Benefit Plan Database. We identified other study variables including all-cause mortality using data from the Registered Persons Database. Encrypted patient identifiers were used to link across databases. Logistic regression models were used to measure potential correlates of deep tissue infections. Results An increase in the incidence of deep tissue infections was observed between 2011 and 2016 for patients on opioid agonist treatment. Additionally, age, sex, positive HIV diagnosis, and all-cause mortality was correlated with deep tissue infection in our study population. Conclusion The study indicates factors that are associated with deep tissue infections in the opioid use disorder population and can be used to identify opportunities to reduce the incidence of new infections.

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“…Infective Endocarditis (IE) is one of the most severe complications in intravenous drug abusers. The tricuspid valve is the most frequently affected [1]. Staphylococcus aureus is the most common etiologic agent [2].…”

Section: Introductionmentioning

confidence: 99%

Infective Endocarditis Related to Intravenous Drug User: Report of Four Cases

Muco¹,

Harxhi²,

Hasa³

et al. 2018

TOIDJ

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Objective:To describe the clinical, laboratory, microbiological, and echocardiographic findings in four intravenous drug users with endocarditis hospitalized and followed in our Infectious Disease Service, a tertiary university hospital as well as to determine the efficacy of medical treatment. Methods:From a database of 35 subjects with endocarditis during five years, we made a retrospective analysis of data for four cases between the age of 24-33 years old which were intravenous drug users. Results:Infective endocarditis was encountered in four drug users with positive blood cultures (Staphylococcus aureus was present in all the cases), vegetations in the tricuspid native valve in ultrasound, high fever (more than 38 o C). The four cases were male and the mean age was 29 years (range 24-33 years). Three out of the four cases presented with pulmonary involvement and only one with femoral and popliteal vein thrombosis. Two out of four cases had acute renal and hepatic failure and only one had acute cutaneous vasculitis. Transesophageal Echocardiography (TEE) was also performed in two cases. For all of them medical management consisted of antibiotic therapy and two out of them underwent surgery because of the persistence of valvular vegetations after antibiotic therapy. The prognosis was good with 0% mortality. Conclusion:Infective endocarditis should be considered in the differential diagnosis of intravenous drug users presenting with various clinical scenarios. Echocardiography remains the main modality and should be used serially to facilitate early diagnosis. The successful management of a complicated case often requires the close cooperation of an infectious disease physician, a cardiologist, an addiction physician and occasionally a cardiac surgeon.

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Infective endocarditis in intravenous drug users: a review article

Cited by 38 publications

References 27 publications

Risk Factors Of Infective Endocarditis In Persons Who Inject Drugs

Risk Factors Of Infective Endocarditis In Persons Who Inject Drugs

A retrospective cohort study evaluating correlates of deep tissue infections among patients enrolled in opioid agonist treatment using administrative data in Ontario, Canada

Infective Endocarditis Related to Intravenous Drug User: Report of Four Cases

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