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Features of infective endocarditis in a contemporary cohort of persons who inject drugs: a matched comparison analysis of long-term prognostic factors

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Abstract

The objective of the study was to assess the short- and long-term mortality of infective endocarditis (IE) among people who inject drugs (PWID). Using prospectively collected data on hospitalized patients (years 2000 through 2021) with IE, PWID were identified and included in this study. Survival analysis was performed to analyze short- and long-term mortality and study their risk factors among PWID and a matched group of non-intravenous drug users (N-IDU). In a study of 485 patients admitted for IE, 55 (11%) of them were PWID. These PWID patients were 1:1 age- and sex- matched to an N-IDU group (N = 55 per group). Both groups had similar baseline comorbid conditions, including congestive heart failure, type 2 diabetes, and neoplastic diseases. However, PWID were more likely to have HCV co-infection (62% vs 16%, respectively, p < 0.001) and advanced liver disease/cirrhosis (52% vs 7.9%, respectively, p < 0.001). IE in PWID more often affected the tricuspid valve (42% vs 22%, respectively, p = 0.024) and presented with more embolic events (66% vs 35%, respectively, p < 0.01). S. aureus was the primary cause of IE in PWID (44% vs 21%, respectively, p = 0.01). After adjusting for other variables, PWID (HR = 2.99, 95% CI [1.06, 8.43], p = 0.038) and valve bioprosthetic replacement (HR = 5.37, 95% CI [1.3, 22.1], p = 0.02) were independently associated with increased mortality risk, whereas IE caused by tricuspid valve infection was associated with reduced mortality risk (HR = 0.25, 95% CI [0.06, 0.97], p = 0.046). In this cohort, PWID had increased risk of long-term mortality after hospital discharge for IE, when compared to matched N-IDU with similar baseline characteristics. The reasons behind the significant increase in mortality warrant further investigation.

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Data availability

The datasets analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

AICD:

Automatic implantable cardioverter–defibrillator

BMI:

Body mass index

CHD:

Congenital heart disease

CHF:

Congestive heart failure

COPD:

Chronic obstructive pulmonary disease

CRP:

C-reactive protein

HCV:

Hepatitis C virus

HIV:

Human immunodeficiency virus

ICE:

International Collaboration on Endocarditis

IHD:

Ischemic heart disease

IE:

Infective endocarditis

INR:

International normalized ratio

N-IDU:

Non-intravenous drug users

NT-proBNP:

N-terminal pro b-type natriuretic peptide

NYHA:

New York Heart Association

PMK:

Pacemakers

PWID:

People who inject drugs

WBC:

White blood cells

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Author information

Author notes

  1. Mohammad Said Ramadan

    Present address: Division of Infectious Diseases, Duke University Medical School, Durham, NC, USA

Authors and Affiliations

  1. Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Via de Crecchio, 7, 80138, Naples, Italy

    Mohammad Said Ramadan, Lorenzo Bertolino, Mahmoud Hamieh, Anna Maria Peluso, Raffaella Gallo, Fabian Patauner & Emanuele Durante-Mangoni

  2. Unit of Infectious & Transplant Medicine, A.O.R.N. Ospedali dei Colli – Ospedale Monaldi, Piazzale Ettore Ruggieri, 80131, Naples, Italy

    Filomena Boccia, Rosa Zampino & Emanuele Durante-Mangoni

  3. Department of Translational Medical Sciences and Unit of Cardiac Surgery, University of Campania “Luigi Vanvitelli”, A.O.R.N. Ospedali dei Colli – Ospedale Monaldi, Piazzale Ettore Ruggieri, 80131, Naples, Italy

    Luca Salvatore De Santo & Antonio Carozza

  4. Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza Luigi Miraglia, 2 80138, Naples, Italy

    Filomena Boccia & Rosa Zampino

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  11. Emanuele Durante-Mangoni
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Consortia

the Monaldi Hospital Cardiovascular Infection Study Group

Corresponding author

Correspondence to Emanuele Durante-Mangoni.

Ethics declarations

Members of the Monaldi Hospital Cardiovascular Infection Study Group

Emanuele Durante-Mangoni MD, PhD, Domenico Iossa PhD, Lorenzo Bertolino MD, Maria Paola Ursi MD, Fabiana D’Amico BSc, Arta Karruli MD, Mohammad Said Ramadan MD, Fabian Patauner MD, Raffaella Gallo MD, Anna Maria Peluso MD, Oriana Infante MD, Roberto Andini MD, Rosa Zampino MD, PhD (internal medicine); Mariano Bernardo MSc, Giuseppe Ruocco MSc (microbiology); Giovanni Dialetto MD, Franco Enrico Covino MD, Sabrina Manduca MD, PhD (echocardiography); Alessandro Della Corte MD, PhD, Luca S. De Santo MD, PhD, Antonio Carozza MD, PhD, Marisa De Feo MD, PhD (cardiac surgery); Gerardo Nigro MD, PhD (electrophysiology); Maria Luisa De Rimini MD (nuclear medicine); Nicola Galdieri MD (intensive care).

Financial support and conflict of interest disclosure

EDM reports research funding for his institution from MSD, Pfizer, Angelini, Infectopharm, and Advanz pharma, and personal fees or fees to participate in advisory boards or speaker’s honoraria from Roche, Genentech, Pfizer, MSD, Angelini, Advanz pharma, Bio-Merieux, Shionogi, Menarini, Abbvie, Sanofi-Aventis, Medtronic, Trx, and DiaSorin.

Human and animal rights

Data collection was approved by the Ethics Committee of the University of Campania “Luigi Vanvitelli” and AORN Ospedali dei Colli (prot. N. AOC/011110/2020). Personal and clinical data were managed in agreement with the Declaration of Helsinki and the General Data Protection Regulation (679/2016).

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All patients provided informed consent to the anonymous use of their clinical data for scientific purposes.

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Ramadan, M.S., Bertolino, L., Boccia, F. et al. Features of infective endocarditis in a contemporary cohort of persons who inject drugs: a matched comparison analysis of long-term prognostic factors. Intern Emerg Med 19, 455–464 (2024). https://doi.org/10.1007/s11739-023-03502-6

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