Low mortality but increasing incidence of Staphylococcus aureus endocarditis in people who inject drugs

Abstract

Staphylococcus aureus is a leading cause of infective endocarditis in people who inject drugs (PWID). The management of S aureus endocarditis (SAE) in PWID can be problematic. The objective of this retrospective observational study was to assess the epidemiology, clinical characteristics, and mortality of S aureus endocarditis (SAE) in PWID in Stockholm, Sweden.The Department of Infectious Diseases at the Karolinska University Hospital serves as a regional referral center for drug users with severe infections. Patients with active intravenous drug use treated for SAE at the department between January 2004 and December 2013 were retrospectively identified. Clinical and microbiological data were obtained from medical records and the diagnosis verified according to the modified Duke criteria.In total, 120 SAE episodes related to intravenous drug use were identified. Its incidence in Stockholm was 0.76/100,000 adult person-years for the entire period, increasing from 0.52/100,000 person-years in 2004 to 2008 to 0.99 in 2009 to 2013 (P = 0.02). The SAE incidence among PWID specifically was 249 (range 153–649) /100,000 person-years. Forty-two (35%) episodes were left-sided, and multiple valves were involved in 26 (22%). Cardiac valve surgery was performed in 10 (8%) episodes, all left-sided. The in-hospital and 1-year mortality rates were 2.5% (3 deaths) and 8.0% (9 deaths), respectively.We noted a high and increasing incidence over time of SAE related to intravenous drug use in Stockholm. The increased incidence partly reflects a rising number of PWID during the study period. The low mortality noted, despite a substantial proportion with left-sided endocarditis, probably in part reflects the quality of care obtained at a large and specialized referral center for drug users with severe infections.

The risk of infective endocarditis among people who inject drugs: a retrospective, population-based time series analysis

“…In this study, we identified a substantial and progressive increase in the risk of infective endocarditis among people who inject drugs, beginning in 2010. This increase in overall risk [5][6][7] and the higher risk among men 18 is consistent with findings from other jurisdictions. We expected this increase to occur in the fourth quarter of 2011, when traditional controlled-release oxycodone was removed from the Canadian market; however, the increase in risk predated this event.…”

“…10 This definition includes patients aged 18 to 55 years who had hospital admissions in the preceding 6 months with diagnoses of opioid, stimulant or combined drug abuse, or infection with hepatitis C. The age restriction reflects the distribution of ages in previously described cohorts of people who inject drugs and in our own validation study. 7,11,12 Compared with chart review, this definition has been shown to have a sensitivity of 93% and a positive predictive value of 83%. 10 We defined infective endocarditis using administrative codes (Supplemental Table 3, Appendix 1).…”

Associations between echocardiographic manifestations and bacterial species in patients with infective endocarditis: a cohort study

“…IV drug abuseKUH has a special ward for addicts with infections, with an uptake area covering Stockholm County Council (approximately 2.3 million inhabitants), which might contribute to the relatively high presence of IV drug abuse among endocarditis patients at KUH. Studies of patients with IE in the USA in 2012-2013 showed a lower incidence of IV drug abuse among IE patients (6.5-7.8% of the IE patients had IV drug abuse) than in our results (32% of the patients had a history of IV drug abuse), although recent US and European studies have noted that the presence of IV drug abuse is generally increasing among patients with IE[23,24]. The high prevalence of IV drug abusers among the IE-patients have affected the association between S. aureus and tricuspid valve vegetation found in this study.…”

Primary infective endocarditis with isolated involvement of the pulmonary valve not associated with drug addiction

“…Чаще всего при ИЭ правых отделов сердца поражается трикуспидальный клапан -до 100 % при ИЭ наркоманов [4,9,10] и у 56,4-82 % больных, не применявших наркотики [5,11]. Другие возможные локализации ИЭ в правых отделах: электроды ЭКС, клапан легочной артерии (ЛА), Евстахиев клапан, Тебезиев клапан, другие малые врожденные аномалии правого предсердия и пристеночное расположение [3,12].…”

“…Другие возможные локализации ИЭ в правых отделах: электроды ЭКС, клапан легочной артерии (ЛА), Евстахиев клапан, Тебезиев клапан, другие малые врожденные аномалии правого предсердия и пристеночное расположение [3,12]. Вовлечение клапана ЛА наблюдается в 0,5-2,9 % всех случаев ИЭ у взрослых [2,3,9] и в 3-20,5 % случаев ИЭ правых отделов сердца, обычно в комбинации с поражением трикуспидального клапана [3,5,9,13].…”