Owing to ongoing infection risk, long-term survival for people who inject drugs who are treated for infective endocarditis is low, according to a recently published study.
“The study was initially prompted by our observation that people who inject drugs (PWID) suffering from infective endocarditis (IE) frequently returned to the hospital with repeated infections,” Jonathan A.T. Sandoe, PhD, associate professor of medicine and health at the University of Leeds, told Infectious Disease News. “There is often a debate about whether PWID should be offered further cardiac surgery after they have been operated on for infective endocarditis but re-present to hospital with infection on their new prosthetic valve because of ongoing intravenous drug use. Some people argue that further surgery is futile if they continue to inject drugs and we wanted to challenge that view.”
Sandoe and colleagues prospectively identified PWID who were treated for infective endocarditis between Jan. 1, 2006, and Dec. 31, 2016, and also included PWID who were hospitalized with other infections as a novel comparison group. The listed outcomes were all-cause mortality, cause of death, relapse, recurrence and re-operation.
According to the study, there were 105 episodes of IE in 92 PWID and 112 episodes of other infections in 107 PWID “in whom IE was suspected but ultimately rejected.” The survival rate at 30 days for the IE group was reported to be 85%, and the 30-day survival rate following surgery was 96%, Sandoe and colleagues reported.
According to the findings, the survival rate for patients with IE at 1, 3, 5 and 10 years was 73.9%, 62.7%, 58.3% and 43.8%, respectively — significantly lower than controls, in whom the corresponding survival rates were 91%, 86.4%, 83.5% and 70%.
The researchers reported that the mortality rate was higher in patients who required surgery compared with those who did not (HR = 1.8, 0.95-3.3). Sandoe said most deaths were related to further infections due to ongoing IV drug use.
“We need to do more to support PWID when they are discharged from hospital; it is not enough just to manage the acute infection,” he said. – by Caitlyn Stulpin
Disclosures: Sandoe participates in research with funding from Pfizer and Merck. Please see the study for all other authors’ disclosures.