Leahey P Alexander, LaSalvia Mary T, Rosenthal Elana S, Karchmer Adolf W, Rowley Christopher F
Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Department of Infectious Diseases, Kaiser Permanente Northwest, Clackamas, Oregon.
Open Forum Infect Dis. 2019 Mar 1;6(4):ofz089. doi: 10.1093/ofid/ofz089. eCollection 2019 Apr.
Hospitalizations for individuals with injection drug use-related infective endocarditis (IDU-IE) represent an increasing portion of all patients with endocarditis. This study describes the evolving trends in demographics, clinical characteristics, rates of surgical intervention, and mortality among patients hospitalized with IE, comparing those with and without injection drug use.
This is a retrospective cohort study of patients admitted between January 1, 2007 to June 30, 2015 at a tertiary care center in Boston, Massachusetts. Endocarditis was defined by code and verified by the modified Duke Criteria for IE. The clinical characteristics, microbiology, site of infection, complications of IE, and outcome were all abstracted by chart review. Rates of surgical consultation and surgical intervention within 90 days of admission were obtained, and assessment of surgical risk calculated was by EuroSCORE II (euroscore.org/calc). Subsequent hospitalizations for all causes were also reviewed.
Injection drug use-related infective endocarditis occurred in younger patients with lower rates of diabetes, renal dysfunction, and prior cardiothoracic (CT) surgery than those without IDU. Injection drug use-related infective endocarditis was associated with higher rates of complications, CT surgery consultation, and surgery within 90 days for absolute surgical indication. Readmissions for endocarditis occurred in 20% of IDU-IE patients and 9% of those with non-IDU IE. All-cause 1-year mortality rates were similar (IDU-IE 16%, non-IDU IE 13%; = .58).
Despite younger age, fewer medical comorbidities, and fewer prior cardiac surgeries, all-cause 1-year mortality was similar for patients after sentinel admission for IDU-IE compared with non-IDU IE. Interventions in the acute hospital setting and after discharge are needed to support patients with IDU-IE, focusing on harm reduction and treatment of addiction to reduce the unexpectedly high mortality of this young population.
与注射吸毒相关的感染性心内膜炎（IDU-IE）患者的住院人数在所有心内膜炎患者中所占比例日益增加。本研究描述了因心内膜炎住院患者在人口统计学、临床特征、手术干预率和死亡率方面的演变趋势，比较了有和没有注射吸毒的患者。
这是一项对2007年1月1日至2015年6月30日期间在马萨诸塞州波士顿一家三级医疗中心住院患者的回顾性队列研究。心内膜炎通过编码定义，并经改良的杜克心内膜炎标准验证。通过病历审查提取临床特征、微生物学、感染部位、心内膜炎并发症和结局。获取入院90天内的手术会诊率和手术干预率，并通过欧洲心脏手术风险评估系统II（euroscore.org/calc）计算手术风险评估。还对所有原因导致的后续住院情况进行了审查。
与无注射吸毒的患者相比，与注射吸毒相关的感染性心内膜炎发生在年龄较小的患者中，糖尿病、肾功能不全和既往心胸（CT）手术的发生率较低。与注射吸毒相关的感染性心内膜炎与较高的并发症发生率、CT手术会诊率以及因绝对手术指征在90天内进行手术的比率相关。20%的IDU-IE患者和9%的非IDU-IE患者因心内膜炎再次入院。全因1年死亡率相似（IDU-IE为16%，非IDU-IE为13%；P = 0.58）。
尽管IDU-IE患者年龄较小、合并症较少且既往心脏手术较少，但与非IDU-IE患者相比，IDU-IE患者首次入院后的全因1年死亡率相似。需要在急性医院环境中和出院后进行干预，以支持IDU-IE患者，重点是减少伤害和治疗成瘾，以降低这一年轻人群意外高的死亡率。
