Long-term Outcomes of Injection Drug-related Infective Endocarditis Among People Who Inject Drugs

Abstract

Objectives: Infective endocarditis (IE) among people who inject drugs is associated with high rates of mortality and repeat episodes of endocarditis. We sought to report on longer-term clinical outcomes of patients with IE who were offered buprenorphine or methadone treatment for opioid use disorder (OUD) at their initial hospital admission. Methods: Individuals with OUD hospitalized between 2013 and 2015 with IE were included for the retrospective study. The following data were extracted from the medical record: sociodemographic data, mortality, repeat episodes of endocarditis, and evidence of ongoing buprenorphine and methadone treatment. The impact of medication use on mortality and repeat episode of endocarditis was examined using survival analysis. Results: Overall, 26 individuals were included in the study. The mean duration of follow-up was 45.0 months (SD 7.2, range 34.0–56.0). During the index admission, 8 received buprenorphine, 8 received methadone, and 10 declined medications. During the follow-up period, 4 (15.4%) individuals died and 10 (38.5%) individuals experienced a repeat episode of endocarditis. Survival analysis of mortality (log-rank P = 0.066) and repeat episode of endocarditis (log-rank P = 0.86) comparing those who received buprenorphine, received methadone, and declined medication did not differ significantly. Conclusions: Initiation of medication treatment alone may not be sufficient to impact long-term mortality and rates of repeat episode of endocarditis. More research is needed to identify optimal treatment strategies for people who inject drugs with IE.

Changing spectrum of infective endocarditis in India: An 11-year experience from an academic hospital in North India

“…Globally, the opioid epidemic has led to increasing admissions for IDU-IE, with substantial health and cost implications. 4 , 5 , 10 , 21 , 27 , 28 Our study, along with a recent study from Punjab, detected an alarming increase in the proportion of IDU-IE in India compared to the previous major IE series ( Supplementary Table 1 ). 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 A continuously increasing ratio of IDU-IE was demonstrated over the years in our study, except for a significant decline from 2014 to 2015 ( Fig.…”

Association of Treatment With Medications for Opioid Use Disorder With Mortality After Hospitalization for Injection Drug Use–Associated Infective Endocarditis

“…MOUD has been extensively investigated, 10 , 11 , 12 , 13 but data describing the association of MOUD receipt with mortality after IDU-IE–related hospitalization are limited. 3 , 4 , 14 , 15 A national study 9 of privately insured individuals with IDU-IE showed that MOUD was associated with decreased rehospitalizations, but smaller studies 3 , 4 , 14 , 15 investigating mortality have had conflicting results. Studies in Ontario 4 and Boston 14 found no association between MOUD receipt and long-term mortality in patients with IDU-IE; a small study in Maine 15 showed that MOUD was associated with decreased 90-day mortality only in unadjusted analyses.…”

A Systematic Review and Meta-Analysis of Studies Evaluating the Effect of Medication Treatment for Opioid Use Disorder on Infectious Disease Outcomes

“…One study investigated infectious endocarditis readmission rates or repeat episodes of endocarditis and their association with MOUD ( Table 1 ) [ 28 ]. Suzuki et al [ 28 ] found that 6 (37.5%) of the 16 participants who initiated MOUD at their initial hospital admission for endocarditis had a repeat episode within the follow-up period (45 months). This did not significantly differ from those who declined MOUD during initial hospitalization and had a repeat episode (4 of 10, 40%).…”

“…One study evaluated infectious endocarditis antimicrobial completion ( Table 1 ) [ 28 ]. Suzuki et al [ 28 ] noted that there was no significant difference in completion of antimicrobial course for endocarditis in those on MOUD compared with those not on MOUD.…”

“…One study evaluated infectious endocarditis antimicrobial completion ( Table 1 ) [ 28 ]. Suzuki et al [ 28 ] noted that there was no significant difference in completion of antimicrobial course for endocarditis in those on MOUD compared with those not on MOUD. Of the 16 participants who initiated MOUD at the index hospitalization, 14 (87%) completed the course of antimicrobials, whereas all 10 (100%) of the non-MOUD participants completed the antimicrobial course.…”