Long-term Outcomes Are Poor in Intravenous Drug Users Following Infective Endocarditis, Even After Surgery
- 3 September 2019
- journal article
- research article
- Published by Oxford University Press (OUP) in Clinical Infectious Diseases
- Vol. 71 (3), 564-571
- https://doi.org/10.1093/cid/ciz869
Abstract
Background Previous studies of outcomes in people who inject drugs (PWID) with infective endocarditis (IE) have often been retrospective, have had small sample sizes, and the duration of follow-up has been short and limited to patients who were operated on. Methods PWID treated for IE between 1 January 2006 and 31 December 2016 were identified from a prospectively collected database. PWID hospitalized with other infections acted as a novel comparison group. Outcomes were all-cause mortality, cause of death, relapse, recurrence, and reoperation. Results There were 105 episodes of IE in 92 PWID and 112 episodes of other infections in 107 PWID in whom IE was suspected but rejected. Survival at 30 days for the IE group was 85%, and 30-day survival following surgery was 96%. The most common pathogens were Staphylococcus species (60%) and Streptococcus species (30%). The surgical intervention rate was 47%. Survival for the IE group at 1, 3, 5, and 10 years was 74%, 63%, 58%, and 44%, respectively. This was significantly lower compared with the comparator group of other infections in PWID (P = .0002). Mortality was higher in patients who required surgery compared with those who did not (hazard ratio, 1.8 [95% confidence interval, .95–3.3]). The commonest cause of death was infection (66%), usually a further episode of IE (55%). Conclusions Although early survival was good, long-term life expectancy was low. This was attributable to ongoing infection risk, rather than other factors known to affect prognosis in PWID. Surgery conferred no long-term survival advantage. More efforts are needed to reduce reinfection risk following an episode of IE in PWID. While early survival for people who inject drugs (PWID) with infective endocarditis is good, long-term survival is poor due to ongoing infection risk. Surgery conferred no long-term survival advantage, so more efforts are needed to reduce reinfection risks for PWID.Keywords
This publication has 23 references indexed in Scilit:
- A Nationwide Cohort Study of Mortality Risk and Long-Term Prognosis in Infective Endocarditis in SwedenPLOS ONE, 2013
- Long-Term Outcome for the Surgical Treatment of Infective Endocarditis With a Focus on Intravenous Drug UsersThe Annals of Thoracic Surgery, 2012
- Ethical Obligation of Surgeons to Noncompliant Patients: Can a Surgeon Refuse to Operate on an Intravenous Drug-Abusing Patient With Recurrent Aortic Valve Prosthesis Infection?The Annals of Thoracic Surgery, 2009
- Clinical Presentation, Etiology, and Outcome of Infective Endocarditis in the 21st CenturyJAMA Internal Medicine, 2009
- Long-Term Outcomes in Valve Replacement Surgery for Infective EndocarditisThe Annals of Thoracic Surgery, 2007
- In-hospital and long-term mortality in infective endocarditis in injecting drug users compared to non-drug users: A retrospective study of 192 episodesScandinavian Journal of Infectious Diseases, 2007
- Infective endocarditisBMJ, 2006
- What are the long-term results of cardiac valve replacements in left sided endocarditis with a history of i.v. drug abuse?Interactive CardioVascular and Thoracic Surgery, 2006
- Epidemiologic Aspects of Infective Endocarditis in an Urban Population: A 5-Year Prospective StudyMedicine, 1995
- Management of Infective Endocarditis: Seventeen Years' ExperienceThe Annals of Thoracic Surgery, 1987