Infective Endocarditis in People Who Inject Drugs: Report from the Italian Registry of Infective Endocarditis

Abstract

Intravenous drug use is a predisposing condition for infective endocarditis (IE). We report the clinical features of IE, taken from the Italian Registry of IE, in people who inject drugs (PWIDs). The registry prospectively collected epidemiological, clinical, in-hospital, and follow-up data on patients with IE from 17 Italian centers. A total of 677 patients were enrolled, and 61 (9%) were intravenous drug users (IDUs). Most PWIDs were male (78.6%), and aged between 41 and 50 years old (50%). The most frequent comorbidities were HIV (34.4%) and chronic liver disease (32%). Predisposing factors for IE were present in 6.5% of the patients, and 10% had minor valvular abnormalities. IE had occurred previously in 16.4% of the patients, and 50% of them had undergone heart surgery. Overall mortality was 9.8% in IDUs and 20% in patients with recurrent IE. IE in PWIDs mostly affected the native valves (90%). The echocardiographic diagnosis of IE was based on the detection of vegetation in 91.82% of cases. Staphylococcus aureus was the main microorganism isolated (70%) from blood cultures. Thirty patients (49%) underwent heart surgery: thirteen had aortic valves, eleven had mitral valves, and six had tricuspid valve interventions. IE in PWIDs was relatively common, and patients with native valve right-sided IE had a better prognosis, with a low rate of surgical interventions.

Mitral valve surgery in acute infective endocarditis: long-term outcomes of mitral valve repair versus replacement

“…Conversely, replacement by means of a prosthetic valve [mitral valve prosthesis (MVP)] is nowadays limited to poorer surgical candidates thus significantly influencing perioperative and short-term results. Of note, this approach should be discouraged in patients with infective endocarditis secondary to intravenous drug abuse to limit the amount of prosthetic material and the incidence of recurrences 8 …”

“…Of note, this approach should be discouraged in patients with infective endocarditis secondary to intravenous drug abuse to limit the amount of prosthetic material and the incidence of recurrences. 8 In this retrospective single-center study, we sought to critically investigate clinical outcomes derived from our institutional approach to patients with severe mitral valve regurgitation secondary to active infective endocarditis. We focused our analysis on the effects of repair or replacement at long-term follow-up.…”

“…Of note, this approach should be discouraged in patients with infective endocarditis secondary to intravenous drug abuse to limit the amount of prosthetic material and the incidence of recurrences. 8 …”

The Changing Complementary Role of Multimodality Imaging in Clinical Cardiology

“…Further studies are needed to assess the usefulness of clinical prediction rules for the avoidance of using echocardiographic evaluation in Staphylococcus aureus bacteraemia patients [ 24 ]. Besides echocardiography, a multimodality of imaging complementary approaches to IE, including cardiac magnetic resonance, computed tomography or positron emission tomography in combination with computed tomography (PET-CT), has gained interest in recent years [ 25 , 26 , 27 ], which could help reach a better understanding of the pathogenesis, clinical profile and outcomes in paediatric, adult and selective groups of IE [ 25 , 26 , 27 ]. Further research on multimodality imaging and the surgical treatment of IE is strongly needed to provide more comprehensive information for defining the most suitable treatment option, finding the optimal time for surgery and reducing morbidity and mortality.…”

Epidemiology, Diagnosis, Treatment, and Prognosis of Infective Endocarditis

“…Cecchi et al [11] present the data from the Italian Registry of IE in people who inject drugs, a predisposing condition that used to be very common. So far, we have primarily received recent information from the United States regarding the American opioid pandemic, so European data are greatly appreciated.…”