Clinical Features, Site of Involvement, Bacteriologic Findings, and Outcome of Infective Endocarditis in Intravenous Drug Users

Abstract

Infective endocarditis in intravenous drug users affects the right and left sides of the heart with approximately equal frequency. At present, more than 90% of cases of infective endocarditis in intravenous drug users in Chicago are caused by staphylococci or streptococci. Involvement of the aortic valve is predictive of increased morbidity and mortality in intravenous drug users with infective endocarditis. With medical treatment, and surgery when medical treatment fails, intravenous drug users with infective endocarditis have an in-hospital survival rate of 91%.

Infective Endocarditis in Intravenous Drug Users from Italy: the Increasing Importance in HIV-infected Patients

“…By multiple logistic regression calculated on the total number of cases, mortality was associated with any left-sided localization (p = 0.0006; OR 5.2; 95% CI 2.0-13.5) and age greater than 35 years (p = 0.0068; OR 3.5; 95% CI 1. [4][5][6][7][8][9]. No statistically significant difference in mortality was observed in HIVnegative versus HIV-positive patients (14.5% vs 8.5%).…”

“…The source of infection can be represented by contaminated needles or dirty syringes, contaminated drugs or diluents used for injections, or by unsterile skin sites [3]. Infective endocarditis in IDUs is more likely to occur on the right side of the heart, with a variable rate of left-side involvement reported [4,5]. Since Staphylococcus aureus is the predominant pathogen isolated, it was hypothesized that unique interactions could occur between S. aureus and unique surface proteins expressed in the face of right-sided endothelial damage [6].…”

Non-traumatic subdural hematoma secondary to septic brain embolism: A rare cause of unexpected death in a drug addict suffering from undiagnosed bacterial endocarditis

“…According to a cohort study of 125 IVDAs with native valve IE, the right and left sides of the heart are affected with approximately equal frequency [15]: The tricuspid valve was involved in 46%, the mitral valve in 25.6%, the aortic valve in 19% and the pulmonary valve in 0.8%. Among the causative microorganisms, staphylococci (65.6 %) and streptococci (25.6 %) predominated.…”

Surgery for infective endocarditis

“…Although injection drug use has generally been associated with right-sided IE, in several recent studies, left-sided infections predominated among this patient population [35,36]. When surgical therapy involves the need for valve replacement, obvious concerns exist related to the risks of continued injection drug use and the subsequent development of PVE.…”