Risk of New Bloodstream Infections and Mortality Among People Who Inject Drugs With Infective Endocarditis

Tan, Charlie; Shojaei, Esfandiar; Wiener, Joshua; Shah, Meera; Koivu, Sharon; Silverman, Michael

doi:10.1001/jamanetworkopen.2020.12974

Cited by 25 publications

(37 citation statements)

References 42 publications

(69 reference statements)

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“…If a patient has demonstrated a pattern of non-adherence and injurious behavior, PICC and even SNF placement may be viewed as unacceptable options given the risk of treatment failure and further morbidity and mortality. In patients with ongoing drug use, new bloodstream infections are common when receiving parenteral treatment for infective endocarditis [23]. While carefully selected PWID can be considered for OPAT at home, there is still a tremendous need to identify alternative treatment strategies for PWID with endovascular infections.…”

Section: Discussionmentioning

confidence: 99%

Dalbavancin in the Treatment of Bacteremia and Endocarditis in People with Barriers to Standard Care

2020

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Introduction: Dalbavancin is an antibiotic administered by intravenous infusion weekly or bi-weekly and is currently FDA-approved only for treatment of skin and soft-tissue infections. It has shown promise, but is not considered the standard of care, for bacteremia and infective endocarditis (IE), which typically require outpatient parenteral antibiotic therapy (OPAT) for prolonged durations. People who inject drugs (PWID) with bacteremia or IE are often perceived as having barriers to OPAT and standard daily-administered antibiotics, prompting off-label use of dalbavancin in this population. Methods: A retrospective review of adult patients receiving at least one dose of dalbavancin for bacteremia or IE was conducted between 1 November 2017 and 31 October 2019. Outcomes and reasons for use of dalbavancin were recorded, including specific barriers to standard therapy. Results: Stated reasons for dalbavancin use in the 18 patients identified included active injection drug use (50%), inability to arrange standard OPAT due to patient adherence or inability to place in skilled nursing facility (SNF) (22%), risk for additional infections or other morbidity with OPAT (22%), and patient preference (6%). In 11 patients (61%) SNF placement was not attempted due to behavioral issues or patient declination. There were five patients who did not complete their intended course of treatment (28%). At 90 days, eight patients (44%) achieved a clinical or biologic cure, six (33%) failed treatment, and four (22%) were lost to follow-up. Conclusion: Dalbavancin may have a role as salvage therapy in the treatment of IE and bacteremia in PWID who have significant barriers to standard treatment.

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Section: Discussionmentioning

confidence: 99%

Dalbavancin in the Treatment of Bacteremia and Endocarditis in People with Barriers to Standard Care

2020

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“…This study cohort was previously reported in a study of blood stream infections in patients while on treatment for infective endocarditis. 13 The focus of the present study was on factors associated with recurrent infective endocarditis within the cohort. Informed consent from participants was not required due to the de-identified and retrospective nature of the study.…”

Section: Study Design and Patient Populationmentioning

confidence: 99%

Peripherally Inserted Central Catheter Line Misuse Among People Who Inject Drugs While on Therapy for Infective Endocarditis

Adams

Elton‐Marshall

Shojaei

et al. 2022

The American Journal of Medicine

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“…PWID also have many non-medical risk factors that likely impact their long-term IE outcomes, including income status and housing insecurity. PWID with IE have high rates of experiencing homelessness, with Canadian retrospective cohort studies reporting rates as high as 17–46% [ 5 , 8 , 9 ]. Homelessness has been associated with a significantly increased risk of death compared to the age-matched general population [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

The Second Heart Program—A multidisciplinary team supporting people who inject drugs with infective endocarditis: Protocol of a feasibility study

et al. 2021

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Introduction Infective endocarditis (IE) is a severe and highly prevalent infection among people who inject drugs (PWID). While short-term (30-day) outcomes are similar between PWID and non-PWID, the long-term outcomes among PWID after IE are poor, with 1-year mortality rates in excess of 25%. Novel clinical interventions are needed to address the unique needs of PWID with IE, including increasing access to substance use treatment and addressing structural barriers and social determinants of health. Methods and analysis PWID with IE will be connected to a multidisciplinary team that will transition with them from hospital to the community. The six components of the Second Heart Team are: (1) peer support worker with lived experience, (2) systems navigator, (3) addiction medicine physician, (4) primary care physician, (5) infectious diseases specialist, (6) cardiovascular surgeon. A convergent mixed-methods study design will be used to test the feasibility of this intervention. We will concurrently collect quantitative and qualitative data and ‘mix’ at the interpretation stage of the study to answer our research questions. Ethics and dissemination This study has been approved by the Hamilton Integrated Research Ethics Board (Project No. 7012). Results will be presented at national and international conferences and submitted for publication in a scientific journal. Clinical trail registrarion Trial registration number: ISRCTN14968657 https://www.isrctn.com/ISRCTN14968657.

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Risk of New Bloodstream Infections and Mortality Among People Who Inject Drugs With Infective Endocarditis

Cited by 25 publications

References 42 publications

Dalbavancin in the Treatment of Bacteremia and Endocarditis in People with Barriers to Standard Care

Dalbavancin in the Treatment of Bacteremia and Endocarditis in People with Barriers to Standard Care

Peripherally Inserted Central Catheter Line Misuse Among People Who Inject Drugs While on Therapy for Infective Endocarditis

The Second Heart Program—A multidisciplinary team supporting people who inject drugs with infective endocarditis: Protocol of a feasibility study

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