Drug use-associated endocarditis increases hospitalization risk for bacterial infections
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Key takeaways:
- Among 1,874 people with DUA-IE, 38% died or had a bacterial infection within 3 years.
- The most common infections were recurrent endocarditis, skin and soft tissue infections and bacteremia.
People with drug use-associated infective endocarditis are at high risk of mortality and future hospitalization for bacterial infections, including endocarditis, skin and soft tissue infections and bacteremia, researchers found.
“Over the last several years, we've gained more awareness in the number of people [who have been] impacted by drug use-associated endocarditis,” Mary C. Figgatt PhD, MPH, postdoctoral researchers at the University of Alabama, Birmingham, told Healio. “We also know other serious bacterial infections similarly impacted people who inject drugs, such as serious skin and soft tissue infections and bloodstream infections.”
She added, “Even still, we know little about what happens to people after endocarditis, and how many people go on to develop other bacterial infections.”
The researchers performed a retrospective cohort study of patients discharged after hospitalization for drug-use associated infectious endocarditis (DUA-IE) in North Carolina, including all documented adult patients in the state with a DUA-IE hospitalization between 2016 and 2020 and who had their first documented DUA-IE hospital discharge between Jan. 1, 2017, and Sept. 30, 2020. Then they estimated the long-term risk of the first incident infection occurring after patients’ initial DUA-IE hospitalization.
A total of 1,874 people with DUA-IE hospitalizations were included in the study. During the 3-year period study period, 38% of patients met the composite outcome of either death or another hospitalization for a selected infection, with 16% of patients dying in the 3 years after the initial 90 days after discharge.
The risk of incident infection rose over the 3 years of follow-up years, with the 1-year, 2-year and 3-year cumulative incidence of a subsequent hospitalization for a serious infection being 18%, 23%, and 29%, respectively.
The highest 3-year cumulative incidences by infection type were recurrent endocarditis (14%), skin and soft tissue infections (14%), bacteremia (9%) and bone/joint infections (5%).
Of the patients who died after the initial 90 days after discharge, the leading causes of death were accidental poisoning such as drug overdose, acute effects of endocarditis and other forms of heart disease, according to the study.
Figgatt explained that although this study did not assess risk factors for these patient outcomes, the topic should be studied with a focus on understanding what interventions work well to prevent mortality and later infections.
“Other research has highlighted how important it is to provide comprehensive care for people hospitalized with drug use-related infections,” she said, adding that medications for opioid use disorder are an evidence-based approach to improve care.
“However, given the social, legal, and structural barriers that many people who use drugs face on a daily basis, interventions should seek to address these underlying barriers while also making it as easy as possible for people to access things like medications,” she concluded.
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