Syed Ishba M, Yanagawa Bobby, Jeyaganth Suganthiny, Verma Subodh, Cheema Asim N
Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
CJC Open. 2021 Mar 9;3(7):896-903. doi: 10.1016/j.cjco.2021.02.015. eCollection 2021 Jul.
There has been a rise in the incidence of injection drug use and associated infective endocarditis.
The clinical outcomes of 39 patients admitted with injection drug use-associated infective endocarditis were collected with a mean follow-up of 14 months. The outcomes were compared for patients treated medically with those undergoing surgical intervention. The mean age was 39 ± 11 years; 54% were female. Thirty-two patients (82%) had native and 7 (18%) prosthetic infective endocarditis. The tricuspid valve was affected in 17 patients (43%), the mitral in 10 (26%), the aortic in 4 (10%), and multiple valves in 8 (20%). Sixteen (41%) patients underwent surgery, and 23 (59%) were treated with medical therapy. The indications for surgery included heart failure, systemic emboli, recurrent infection, and vegetation size ≥10 mm. Patients undergoing surgery had a higher rate of paravalvular abscess (25% vs 0%, = 0.02), valve perforation (37% vs 11%, = 0.04), and mitral valve involvement (44% vs 13%, = 0.06), whereas medically treated patients had higher tricuspid valve involvement (61% vs 19%, = 0.02). During follow-up, 26% of medical and 31% of surgical cohort patients died ( = 0.7). Mortality was highest (54%) among those who continued medical management despite an indication for surgery. Univariate predictors of mortality were age (odds ratio [OR] 1.09, 95% confidence interval [CI]: 1.01-1.17; = 0.02), heart failure (OR 6.9; 95% CI: 1.24-37.49; = 0.02), septicemia (OR 4.40; 95% CI:0.99-19.54; = 0.05), and shock (OR 10.8; 95% CI: 1.68-69.92; = 0.01).
Despite contemporary therapy, patients with injection drug use-associated infective endocarditis remain at high risk of complications and poor clinical outcomes. These findings highlight the need for developing new care pathways and a team approach for effective management.
注射吸毒及相关感染性心内膜炎的发病率呈上升趋势。
收集39例因注射吸毒相关感染性心内膜炎入院患者的临床结局，平均随访14个月。比较接受药物治疗的患者与接受手术干预的患者的结局。平均年龄为39±11岁；54%为女性。32例患者（82%）患原发性感染性心内膜炎，7例（18%）患人工瓣膜感染性心内膜炎。17例患者（43%）三尖瓣受累，10例（26%）二尖瓣受累，4例（10%）主动脉瓣受累，8例（20%）多瓣膜受累。16例（41%）患者接受了手术，23例（59%）接受了药物治疗。手术指征包括心力衰竭、全身性栓塞、反复感染和赘生物大小≥10mm。接受手术的患者瓣周脓肿发生率较高（25%对0%，P=0.02）、瓣膜穿孔发生率较高（37%对11%，P=0.04）以及二尖瓣受累发生率较高（44%对13%，P=0.06），而接受药物治疗的患者三尖瓣受累发生率较高（61%对19%，P=0.02）。在随访期间，药物治疗组和手术治疗组分别有26%和31%的患者死亡（P=0.7）。尽管有手术指征但仍继续接受药物治疗的患者死亡率最高（54%）。死亡率的单因素预测因素为年龄（比值比[OR]1.09，95%置信区间[CI]：1.01-1.17；P=0.02）、心力衰竭（OR 6.9；95%CI：1.24-37.49；P=0.02）、败血症（OR 4.40；95%CI：0.99-19.54；P=0.05）和休克（OR 10.8；95%CI：1.68-69.92；P=0.01）。
尽管有现代治疗方法，但注射吸毒相关感染性心内膜炎患者仍有发生并发症和临床结局不良的高风险。这些发现凸显了开发新的护理途径和采用团队方法进行有效管理的必要性。
