Injection Drug Use Endocarditis: An Inner-City Hospital Experience.

BACKGROUND

There has been a rise in the incidence of injection drug use and associated infective endocarditis.

METHODS

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).

CONCLUSIONS

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.