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Recurrent Endocarditis in Persons Who Inject Drugs
Laura Rodger1, Meera Shah1, Esfandiar Shojaei2
1Schulich School of Medicine, Western University London ON, Canada London ON, Canada.
Open Forum Infectious Diseases
|October 30, 2019
Summary
Persons who inject drugs (PWID) face a high risk of recurrent infective endocarditis (IE), especially with peripherally inserted central catheter (PICC) line abuse. Fungal IE in PWID is linked to increased mortality, warranting consideration of antifungal therapy.
Area of Science:
- Infectious Diseases
- Cardiology
- Public Health
Background:
- Infective endocarditis (IE) incidence is rising among persons who inject drugs (PWID), presenting significant morbidity and mortality.
- Recurrent IE within the PWID population is not well-characterized, necessitating further investigation into its specific risk factors and outcomes.
Purpose of the Study:
- To characterize recurrent IE in PWID.
- To identify risk factors associated with recurrent IE in this population.
- To determine the frequency of fungal endocarditis and its impact on mortality.
Main Methods:
- Retrospective cohort study from February 2007 to March 2016.
- Inclusion of adult inpatients with definite IE (Modified Duke's Criteria) across three tertiary care centers.
- Analysis focused on identifying recurrence patterns, risk factors (e.g., PICC line abuse), fungal IE prevalence, and mortality associations.
Main Results:
- Of 212 PWID with IE, 32.1% experienced a second episode, and 12% had further recurrences.
- Peripherally inserted central catheter (PICC) line abuse was significantly associated with increased risk of recurrent IE (OR, 1.97; P = .04).
- Fungal IE was more prevalent in second episodes (7.4%) versus first episodes (0.5%) among PWID and associated with higher mortality (aOR, 16.49; P = .041).
Conclusions:
- PWID exhibit a high risk for recurrent IE, with PICC line abuse being a notable risk factor.
- Fungal IE is more common in recurrent cases among PWID and carries a significantly increased mortality risk.
- Empiric antifungal therapy should be considered for PWID with a history of IE presenting with suspected IE.
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