Staphylococcal septicaemia and endocarditis in 80 drug addicts. Aspects on epidemiology, clinical and laboratory findings and prognosis.

During 1965-1980, 80 intravenous drug addicts with staphylococcal septicaemia with or without endocarditis were admitted to the Roslagstulls Hospital. The mean age was 28.8 (range 16-57) years. 42 were females and 38 were males. Endocarditis was diagnosed in 36 of 80 (45%) and suspected in 18 of 80 (22.5%). Septicaemia alone was found in the remaining 26 patients (32.5%). The median interval between onset of disease and institution of adequate therapy for patients without endocarditis was four days and for endocarditis cases eight days. Most patients had septic toxic symptoms. Respiratory tract symptoms were most common in patients with tricuspid valve endocarditis. Tricuspid valve engagement, manifested as pulmonary septic embolism, was present in 33 of 36 (91.7%) of the episodes of endocarditis. Among these patients, murmurs were only present in 23. Haematuria was significantly more often found in patients with endocarditis than in other groups of patients. Otherwise, laboratory data could not differentiate between patients with or without endocarditis. The outcome was lethal in five patients (6.3%): Tricuspid endocarditis (one); left-sided endocarditis (two); suspected endocarditis and retrosternal abscess (one); septicaemia (one). An unfavourable outcome was correlated to patient's delay, severe underlying diseases and/or lack of co-operation. By 1983 another 12 of the patients had died, two of them from endocarditis and one from pneumonia.