Infectious Disease

Within the case of infectious endocarditis, mortality is decrease in injected drug customers in comparison with non-users

February 01, 2021

3 min read

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Disclosure:
One study author reports that he received a personal research grant from the Institut d’Investigacions Biomèdiques August Pi i Sunyer. The other study authors and the editorial authors do not report any relevant financial information.

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Those with infectious endocarditis who inject drugs may have better chances of survival than non-users. This is evident from research published in the Journal of the American College of Cardiology.

The researchers found that in people with infectious endocarditis, those who injected drugs were more likely to be younger men and their cases were more likely to involve left-sided valves and prosthetic valves.

Person injecting drugs

Source: Adobe Stock

“People who inject drugs are traditionally a group at a higher risk of infectious endocarditis due to the possible direct inoculation of microorganisms into the bloodstream by syringes, especially in poor hygiene conditions and when using non-sterile excipients and direct valve damage secondary to injection, in particular in right-sided cases, “wrote Dr. Juan M. Pericàs, MD, PhD, MPH, of the Infectious Diseases Department of the Hospital Clinic-IDIBAPS, University of Barcelona, ​​Spain, and colleagues. “The so-called ‘opioid crisis’ in the US, Canada and other countries such as Australia has led to a sharp increase in infectious endocarditis cases in people who inject drugs.”

For this analysis, researchers included participants from the ICE-PCS and ICE-Plus cohorts, including 8,112 cases of infectious endocarditis. The researchers compared the results between people who injected drugs and those who did not, and performed logistic regression analyzes to determine risk factors for 6-month mortality and relapse in people who injected drugs.

Risk factors for infectious endocarditis, mortality

Patients who injected drugs tended to be younger (mean age 37 vs. 63 years; P <0.001) and more often men (73% vs. 67%; P = 0.007) than those who did not and presented lower rates of comorbidity other than HIV (13.6% versus 0.8%; P <0.001), liver disease (8.9% versus 3.8%; P <0.001), and higher rates of early infectious endocarditis (19.7% versus 9.4%) ; P <0.001).

Among the people who injected drugs, 53% of infectious endocarditis cases were left valve and 34.5% were left-sided only.

According to the study, people who injected drugs made up the majority of patients with native infectious endocarditis (90.2% versus 64.4%; P <0.001), while prosthetic infectious endocarditis (9.3% versus 27%; P < 0.001). and infections with implantable electronic devices were more common in non-users (0.5% versus 8.6%; P <0.001).

The researchers also observed that Staphylococcus aureus was the cause of 65.9% of infectious endocarditis in injected drug users and 26.8% of cases in non-users (P <0.001).

In addition, people who injected drugs had a higher rate of systemic embolism (51.1% versus 22.5%; P <0.001) and persistent bacteremia (14.7% versus 9.3%; P <) compared to non-users 0.001).

In addition, cardiac surgery was less common in patients who injected drugs (39.5% versus 47.8%; P <0.001) and they experienced lower in-hospital rates (10.8% versus 18.2%; P < 0.001) and 6-month mortality (14.4% vs 22.2%; P <0.001) compared to non-users; However, relapses were more common among injected drug users (9.5% versus 2.8%; P <0.001).

“Although relapses are more common in people who inject drugs, infectious endocarditis in people who inject drugs is associated with better survival rates than infectious endocarditis in non-people who inject drugs. Left-sided infectious endocarditis, prosthetic valve endocarditis, and non-S. Aureus infectious endocarditis is relatively common in people who inject drugs, ”the researchers wrote. “Heart surgeries are linked to improved survival and have largely been performed on people who inject drugs, especially in cases of left-sided infectious endocarditis. Approaching people who inject drugs with a respectful demeanor and offering the option of heart surgery when appropriate, as well as adequate harm reduction and substance abuse disorder treatment services are crucial elements of management. “

Effects of addiction medicine management

“While cited as necessary, ICE researchers did not evaluate the effects of managing addiction medicine,” wrote Dr. Larry M. Baddour, Professor of Medicine in the Department of Infectious Diseases and Internal Medicine at the Mayo Clinic, and colleagues posted a related editorial. “We know this is critical as consulting this management during Index infectious endocarditis hospitalization can reduce the likelihood of readmission for severe infections and improve completion of parenteral antimicrobial therapy.

“Infectious endocarditis in people who inject drugs is a global problem and requires complex strategies to combat this epidemic,” the editors wrote. “Lifelong interventions will be needed to reduce relapse of injectable drug use in people who inject drugs who have developed and survived infectious endocarditis as they remain at high risk for subsequent attacks of infectious endocarditis regardless of who whether they continue to inject drugs or not. “

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