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Left-sided infective endocarditis in persons who inject drugs
Glen Huang1, Kyle A Davis2, S Allan Petty3
1Department of Internal Medicine, Wake Forest Baptist Health, Winston-Salem, NC, 27157, USA. huanglen@gmail.com.
Infection
|February 27, 2020
Summary
Left-sided infective endocarditis (LSIE) is common in persons who inject drugs (PWID). LSIE in PWID requires more valve surgery and has higher mortality than non-LSIE in PWID, with increased stroke risk compared to non-PWID LSIE.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Infective endocarditis (IE) is a serious infection affecting heart valves.
- Persons who inject drugs (PWID) are at increased risk for IE, particularly right-sided IE.
- Left-sided infective endocarditis (LSIE) in PWID is less understood but carries significant morbidity and mortality.
Purpose of the Study:
- To characterize LSIE in PWID.
- To compare LSIE in PWID with non-LSIE in PWID.
- To compare LSIE in PWID with LSIE in non-PWID.
Main Methods:
- Retrospective single-center study.
- Inclusion of adult IE patients from 2011 to 2018.
- Comparison of three groups: PWID with LSIE, PWID with non-LSIE, and non-PWID with LSIE.
Main Results:
- LSIE in PWID was associated with older age, fewer Staphylococcus aureus infections, more cardiac surgery, and higher 10-week mortality compared to non-LSIE in PWID.
- PWID with LSIE were younger, had more multi-valve involvement, more S. aureus infections, previous IE, and strokes compared to non-PWID with LSIE.
- Ten-week mortality was similar between PWID with LSIE and non-PWID with LSIE.
Conclusions:
- LSIE is a significant concern in PWID.
- LSIE in PWID presents differently than non-LSIE in PWID, with increased need for surgery and higher mortality.
- While stroke risk is elevated in LSIE among PWID compared to non-PWID, overall mortality is comparable.
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