Surgical treatment of infective endocarditis in active intravenous drug users: a justified procedure?

Abstract

BackgroundInfective endocarditis is a life threatening complication of intravenous drug abuse, which continues to be a major burden with inadequately characterised long-term outcomes. We reviewed our institutional experience of surgical treatment of infective endocarditis in active intravenous drug abusers with the aim of identifying the determinants long-term outcome of this distinct subgroup of infective endocarditis patients.MethodsA total of 451 patients underwent surgery for infective endocarditis between January 1993 and July 2013 at the University Hospital of Heidelberg. Of these patients, 20 (7 female, mean age 35 ± 7.7 years) underwent surgery for infective endocarditis with a history of active intravenous drug abuse. Mean follow-up was 2504 ± 1842 days.ResultsStaphylococcus aureus was the most common pathogen detected in preoperative blood cultures. Two patients (10%) died before postoperative day 30. Survival at 1, 5 and 10 years was 90%, 85% and 85%, respectively. Freedom from reoperation was 100%. Higher NYHA functional class, higher EuroSCORE II, HIV infection, longer operating time, postoperative fever and higher requirement for red blood cell transfusion were associated with 90-day mortality.ConclusionsIn active intravenous drug abusers, surgical treatment for infective endocarditis should be performed as extensively as possible and be followed by an aggressive postoperative antibiotic therapy to avoid high mortality. Early surgical intervention is advisable in patients with precipitous cardiac deterioration and under conditions of staphylococcal endocarditis. However, larger studies are necessary to confirm our preliminary results.

Current profile of infective endocarditis in intravenous drug users: The prognostic relevance of the valves involved

“…Consistent with other studies, our series of IE in IDUs is formed mainly by HIV-seropositive young males (male:female ratio 6:1), with frequent previous IE episodes and mainly community-acquired [3,4,7,8].…”

“…IDUs have been classically related to RSIE with an incidence ranging from 0.7 to 13/1000 years [6]. Nevertheless, in the last decades, IE episodes in IDUs have decreased, being nowadays responsible for one third of all RSIE [2] and 2% to 5% of all IE episodes [3]. Our study confirms this data and also some relevant differences between RSIE and LSIE.…”

“…Nevertheless, in the last decades, IE episodes in IDUs have decreased, being nowadays responsible for one third of all RSIE [2] and 2% to 5% of all IE episodes [3]. Our study confirms this data and also some relevant differences between RSIE and LSIE.Consistent with other studies, our series of IE in IDUs is formed mainly by HIV-seropositive young males (male:female ratio 6:1), with frequent previous IE episodes and mainly community-acquired [3,4,7,8]. …”

Evaluation of Infection Resistance of Biodegradable versus Conventional Annuloplasty Rings in an in vivo Rat Subcutaneous Model

“…Despite the observed low rates of annuloplasty ring infection, rings can also be infected following the operation or during an invasive diagnostic procedure or intervention in the long term if bacteremia occurs [25,26,27,28]. …”

Skurðaðgerðir við hjartaþelsbólgu á Íslandi 1997-2013

“…Skýringin á þessu er ekki augljós en hugsanlega gaeti gott aðgengi þessara sjúklinga að heilbrigðisþjónustu verið hluti af skýringunni. 1,23,24 Tímalengd sýklalyfjagjafar teygði sig allt frá einni og upp í 10 vikur eftir aðgerð, en að meðaltali tók meðferðin 19 daga fyrir og 4,4 vikur eftir aðgerð. Þessi tímalengd sýklalyfjagjafar er í samraemi við leiðbeiningar European Heart Society (ESC) þar sem maelt er með meðferð í 2-6 vikur en tímalengdin raeðst meðal annars af því hvort um sýkingu í gerviloku sé að raeða eða ekki.…”