Log in to MyACC
Mortality in First-Episode Infective Endocarditis Among Persons Who Inject Drugs
Study Questions:
What are the clinical characteristics and variables associated with mortality in first-episode infective endocarditis among persons who inject drugs (PWID)?
Methods:
This case series studied PWID treated for a first episode of infective endocarditis between April 1, 2007 and March 30, 2016. Participants were adult patients (ages ≥18 years) admitted to any of three hospitals in London, Ontario, Canada. Main outcome measures were survival among PWID; the causative organisms, site of infection, and cardiac and noncardiac complications; referral to addiction services; and surgical versus medical management.
Results:
Of 370 total first-episode cases of infective endocarditis, 202 (54.6%) were in PWID. Among PWID, 105 (52%) were male, the median (interquartile range) age was 34 (28-42) years, and patients were predominantly positive for hepatitis C virus (69.8% [141 of 202]). Right-sided infection was more common (61.4% [124 of 202]), and most infections were caused by Staphylococcus aureus (77.2% [156 of 202]). Surgery occurred in 19.3% of patients (39 of 202). The all-cause mortality rate was 33.7% (68 of 202). Adjusting for age and sex, survival analysis demonstrated that surgery was associated with lower mortality (hazard ratio [HR], 0.44; 95% confidence interval [CI], 0.23-0.84; p = 0.01), as was referral to addiction treatment (HR, 0.29; 95% CI, 0.12-0.73; p = 0.008). Higher mortality was associated with left-sided infection (HR, 3.26; 95% CI, 1.82-5.84; p < 0.001) and bilateral involvement (HR, 4.51; 95% CI, 2.01-10.1; p < 0.001).
Conclusions:
This study presents the demographic characteristics of first-episode infective endocarditis in PWID. The results highlight the potentially important role of addiction treatment in this population. The authors concluded that further study to optimize selection criteria for surgery in PWID is warranted.
Perspective:
PWID represent a distinct demographic population of patients with infective endocarditis. Many centers do not perform valve surgery on these patients owing to concerns about poor outcomes, and addiction services are underused in many hospitals. This observational report describes factors associated with higher mortality risk, including left-sided or combined right- and left-sided infection; lower mortality associated with surgery in an adjusted analysis (but not in the unadjusted analysis) is provocative, but unmeasured confounding factors cannot be excluded.
Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Valvular Heart Disease, Cardiac Surgery and VHD, Interventions and Structural Heart Disease
Keywords: Cardiac Surgical Procedures, Endocarditis, Endocarditis, Bacterial, Hepacivirus, Heart Valve Diseases, Outcome Assessment, Health Care, Staphylococcal Infections, Staphylococcus aureus, Substance Abuse, Intravenous, Survival Analysis
< Back to Listings
