Epidemiology, Microbiology, and Clinical Outcomes Among Patients With Intravenous Drug Use-Associated Infective Endocarditis in New Brunswick

• Published in: CJC open (Online) 2020-09, Vol.2 (5), p.379-385
• Main Authors: Mosseler, Kimiko, Materniak, Stefanie, Brothers, Thomas D., Webster, Duncan
• Format: Article
• Language: English
• Subjects: Original
• ISSN: 2589-790X; 2589-790X
• DOI: 10.1016/j.cjco.2020.05.002

Within the context of Canada’s opioid crisis, medical complications associated with intravenous drug use (IVDU) are increasing. Infective endocarditis (IE) is a serious complication of IVDU, and understanding the characteristics of these patients could aid health systems, clinicians, and patients in the optimization of treatment and prevention of IVDU-IE. At a tertiary care hospital in southern New Brunswick, we conducted a retrospective chart review to identify patients with IVDU-IE admitted between January 1, 2013, and December 31, 2017. We collected data related to the epidemiology, microbiology, clinical manifestations, echocardiography, complications during hospital admission, and outcomes. Forty-two cases of IVDU-IE met inclusion criteria. The rate of IVDU-IE increased from 2.28 per 100,000 population in 2014 to 4.00 in 2017, which, although not statistically significant, reflects patterns in other jurisdictions. Most patients (72.4%) were male, and the mean age was 38.3 (±11.5) years. Most patients (79.3%) injected opioids. The most common clinical sign was fever (90.5%), and Staphylococcus aureus (61.9%) was the most common microorganism. The tricuspid valve was most commonly infected (58.5%), 50% of cases had heart failure as a complication during admission, and 45.2% of cases required valve replacement or repair. The 2-year survival rate after admission for initial IVDU-IE episode was 62.0% (95% confidence interval: 36.5-79.7). IVDU-IE is common in New Brunswick and may be increasing. Despite the relatively young age of this patient population, IVDU-IE is associated with significant morbidity and mortality. Expanding effective harm reduction and addiction treatment strategies for this cohort is recommended. Dans le contexte de la crise des opioïdes au Canada, les complications médicales liées à l'utilisation de drogues par voie intraveineuse (UDIV) sont en augmentation. L'endocardite infectieuse (EI) est une complication grave de l'UDIV, et la compréhension des caractéristiques de ces patients pourrait aider les systèmes de santé, les cliniciens et les patients à optimiser le traitement et la prévention de l’EI liée à l’UDIV (EI-UDIV). Dans un hôpital de soins tertiaires du sud du Nouveau-Brunswick, nous avons effectué un examen rétrospectif des dossiers afin d'identifier les patients atteints de l’EI-UDIV admis entre le 1er janvier 2013 et le 31 décembre 2017. Nous avons recueilli des données relatives à l'épidémiologie, la microbiologie, les ma