Management of Infective Endocarditis Secondary to Injection Drug Use: Practical Recommendations for Clinicians From a...

Area of Science:

• Cardiology
• Infectious Diseases
• Addiction Medicine

Background:

• Drug-use associated endocarditis (DUA-IE) management is often fragmented, involving multiple medical specialties.
• A holistic, person-centered, and multidisciplinary care model offers significant benefits for DUA-IE patients.
• Diagnosis presents an opportunity for comprehensive care, including co-infection screening and addressing socioeconomic factors.

Purpose of the Study:

• To review current literature and clinical insights on managing DUA-IE.
• To advocate for a structured, multidisciplinary approach to DUA-IE care.
• To discuss the benefits of harm reduction strategies and updated treatment paradigms for DUA-IE.

Main Methods:

• Literature review synthesizing existing research on DUA-IE management.
• Incorporation of clinical experience from a writing group of specialists.
• Analysis of current treatment trends, including partial-oral antibiotic regimens and surgical candidacy criteria.

Main Results:

• Multidisciplinary teams are fundamental for optimal DUA-IE patient care.
• Harm reduction strategies (e.g., sterile equipment, opioid agonist therapy, naloxone) are evidence-based for substance use management.
• Surgical decisions for DUA-IE patients should be systematic and team-based, avoiding non-evidence-based criteria like mandatory abstinence.

Conclusions:

• Individualized, multidisciplinary care is essential for effective DUA-IE management.
• Partial-oral antibiotic regimens may improve adherence and access for this population.
• Adoption of harm reduction principles and evidence-based surgical criteria improves clinical outcomes in DUA-IE.