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Staphylococcus aureus endocarditis associated with injecting new psychoactive substances.

S S Joshi1, N Henderson2, D J Griffith3

  • 1Department of Cardiology, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SA, UK, shrutijoshi1@nhs.net.

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New psychoactive substance (NPS) injection drug use led to a fourfold increase in Staphylococcus aureus infective endocarditis (IE) among people who inject drugs (PWID). Complications were higher in PWID, but mortality was similar to non-PWID.

Keywords:
Staphylococcus aureuscardiologyechocardiographyinfective endocarditisnew psychoactive substances

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Area of Science:

  • Infectious Diseases
  • Cardiology
  • Public Health

Background:

  • Observed increase in Staphylococcus aureus infective endocarditis (IE) linked to new psychoactive substance (NPS) injection in Edinburgh (2014-2016).
  • Compared NPS-associated IE in people who inject drugs (PWID) with IE in non-PWID.

Purpose of the Study:

  • To investigate the incidence, characteristics, and outcomes of NPS-associated S. aureus IE in PWID.
  • To compare these cases with S. aureus IE in a non-injecting population.

Main Methods:

  • Retrospective comparison of S. aureus IE cases diagnosed between January 2014 and May 2016.
  • Inclusion criteria: NPS use and drug injection for the case group; no drug injection for the control group.

Main Results:

  • Fourfold increase in annual S. aureus IE incidence, primarily driven by NPS use in PWID.
  • PWID group showed larger vegetation diameter (1.7 cm vs 0.65 cm) and significantly more embolic complications (15 vs 1).
  • No significant difference in 90-day mortality between PWID and non-PWID groups (p=0.39).

Conclusions:

  • NPS-associated S. aureus IE presents with distinct complications, including deep organ embolic abscesses, compared to non-PWID IE.
  • Targeted public health and legislative interventions successfully reduced the incidence of NPS-associated IE.