Department of Anesthesiology and Perioperative Medicine, University Hospitals/Case Western Reserve University, Cleveland, OH, USA.
Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV, USA.
Am J Case Rep. 2021 Mar 29;22:e927385. doi: 10.12659/AJCR.927385.
BACKGROUND Intravenous drug use is an epidemic in the United States. One of the complications of intravenous drug use can be infective endocarditis. The treatment for this disease is a combination of intravenous antibiotics, cardiac surgery consultation, and multidisciplinary psychiatric care. Despite surgical intervention, recurrence of disease is common. In the setting of recurrent infective endocarditis in the setting of intravenous drug use, the ethics of redo cardiac surgery has not been well-established. CASE REPORT A 34-year-old man with history of intravenous drug use presented on 3 separate occasions with infective endocarditis resulting in 3 tricuspid valve surgeries within fewer than 7 months. He said he had not injected drugs since before his first operation, he was considered to have a strong social support system, and he completed his postoperative antibiotic regimens each time. However, prior to his last operation, the patient had a urine drug screen positive for opiates without recorded prescribed opioids. Pathology reports from the 3 intraoperative specimens showed different pathogens each time. An extensive interprofessional discussion ensued. CONCLUSIONS Infective endocarditis in the setting of intravenous drug use and its treatments continue to be a point of ethical and medical discussion for all professionals involved with the care of these patients. This case could be used as an example of individualized decision-making, with rigorous ethical and medical discussion factoring into each decision for cardiac surgery. The ongoing treatment for patients with recurrent endocarditis in the setting of intravenous drug use requires more research and guidelines to help medical professionals better care for this patient population.
静脉注射毒品在美国是一种流行现象。静脉注射毒品的一种并发症可能是感染性心内膜炎。这种疾病的治疗方法是静脉内使用抗生素、心脏手术咨询和多学科精神科护理的组合。尽管进行了手术干预，但疾病的复发仍然很常见。在静脉注射毒品引起的复发性感染性心内膜炎的情况下，再次进行心脏手术的伦理问题尚未得到很好的确立。
一名 34 岁男性，有静脉注射毒品史，因感染性心内膜炎在不到 7 个月的时间内进行了 3 次三尖瓣手术。他说他在第一次手术前没有注射过毒品，他有一个强大的社会支持系统，并且每次都完成了术后抗生素治疗方案。然而，在他最后一次手术前，患者的尿液药物筛查呈阿片类药物阳性，而没有记录的阿片类药物处方。3 次术中标本的病理报告显示每次都有不同的病原体。随后进行了广泛的跨专业讨论。
静脉注射毒品引起的感染性心内膜炎及其治疗方法继续成为所有参与这些患者护理的专业人员的伦理和医学讨论点。这个病例可以作为个体化决策的一个例子，严格的伦理和医学讨论纳入了每次心脏手术的决策。在静脉注射毒品引起的复发性心内膜炎的持续治疗中，需要更多的研究和指南来帮助医疗专业人员更好地照顾这一患者群体。
