Drug Use-Associated Infective Endocarditis: An Emerging Public Health Issue

There has been a marked increase in the rates of overall hospitalizations and hospital stays that include surgery for drug use-associated infective endocarditis, according to study results published in the Annals of Internal Medicine. In addition, cardiac valve replacements as a result of drug use-associated infective endocarditis account for nearly half of all surgeries related to infective endocarditis performed in the state of North Carolina, noted the researchers.

The incidence of drug use-associated infective endocarditis has been increasing in direct correlation with the growth of the opioid epidemic. A prolonged course of intravenous antibiotics is the standard of care for infective endocarditis, and surgical valve replacement is also often part of the treatment regimen. Valve surgery for drug use-associated infective endocarditis has been controversial, however, because of concerns regarding postoperative injection drug use along with the associated risk for prosthetic valve infection. In this study, researchers examined hospitalization trends for drug use-associated infective endocarditis, the proportion of hospitalizations with surgery, and other measures for the state of North Carolina, which may be reflective of nationwide trends.

A total of 22,825 hospitalization for infective endocarditis occurred during the 10-year study period, and of these, 2602 (11%) were for drug use-associated infective endocarditis and 20,223 (89%) for non-drug use-associated infective endocarditis. Valve surgery was performed in 1655 (7%) patients of the total cohort. Hospital admissions as a result of infective endocarditis increased from 1936 cases in 2007 to 2992 cases in 2017, which extrapolated to 27.74 per 100,000 persons in the first year and 37.80 in the final year of the study. Hospitalizations for valve surgery as a result of infective endocarditis cases increased from 1.62 per 100,000 persons to 3.26 per 100,000 persons from the first year to the last year. Cases involving drug use comprised 2240 hospitalizations (10%) for drug use associated infective endocarditis and 20,585 (90%) for non-drug use-associated infective endocarditis; 233 (14%) of those with drug use associated infective endocarditis and 1422 (86%) of those with non-drug use-associated infective endocarditis underwent surgery.

“Drug use-associated [infective endocarditis] is a critical, emerging public health issue that [affects] the lives of young persons, burdening health systems and public insurance payers, and fundamentally reshaping the epidemiology and management of endocarditis,” wrote the researchers.

Reference

Schranz AJ, Fleischauer A, Chu VH, Wu LT, Rosen DL. Trends in drug use-associated infective endocarditis and heart valve surgery, 2007 to 2017: a study of statewide discharge data [published online December 4, 2018]. Ann Intern Med. doi:10.7326/M18-2124