Patients with infective endocarditis and history of injection drug use in a Swedish referral hospital during 10 years

Abstract

Background Patients 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. Methods Data 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. Results Of 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). Conclusions This 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.

Association of COVID-19 with endocarditis in patients with cocaine or opioid use disorders in the US

“…The risk was significantly lower in Black than White people and lower in Hispanic than non-Hispanic people, after propensity-score matching for other demographics, socioeconomic factors, comorbidities, and medical procedures. Since the risk of developing infective endocarditis is higher in injection drug use (IDU) patients [30] our findings are consistent with the higher prevalence of IDU in whites than in blacks or Hispanics [31].…”

Opioid Injection-Associated Bacterial Infections in England, 2002–2021: A Time Series Analysis of Seasonal Variation and the Impact of Coronavirus Disease 2019

“…We also found that injection-associated infections were more common in summer. To our knowledge, this pattern has only been observed in 2 small studies [ 7 , 42 ]. This pattern has been observed for Staphylococcal infections generally [ 23 ], which may be due to sweating and proliferation of colonized bacteria, insect bites, or close contact for example via contact sports.…”

“…Many other infections have seasonal patterns that have informed public health responses, such as seasonal immunization campaigns and heightened hospital infection control measures in winter. Bacterial skin infections in the general population are more common in summer [ 23 ], and studies in New York in the 1990s and Stockholm between 2007 and 2018 suggest that the rate of injection-associated infections is also higher in summer [ 7 ].…”

ESC guidelines 2023 on the management of endocarditis

“…The standard 4-6-week regimen should be used in the remaining patients or when therapy with antibiotics other than penicillinase-resistant penicillins are used. 330,[739][740][741][742][743][744] When the conventional i.v. route therapy is not possible, S. aureus right-sided IE in PWID may also be treated with oral ciprofloxacin (750 mg twice a day) plus rifampin (300 mg twice a day) if the strain is susceptible to both drugs, the case is uncomplicated, and patient adherence is monitored carefully.…”