Clinical Scorecard: Long-Term Outcomes of Infective Endocarditis in Injecting Drug Users: A Five-Year Retrospective Study
At a Glance
Category
Detail
Condition
Infective endocarditis (IE) in persons who inject drugs (PWID)
Key Mechanisms
Right-sided cardiac valve involvement, septic pulmonary emboli, Staphylococcus aureus etiology, ongoing risk due to continued intravenous drug use
Target Population
Adults with infective endocarditis who inject drugs (PWID) and non-PWID adults with community-acquired IE
Care Setting
Hospital-based diagnosis and treatment in Southern Finland, including addiction specialist consultation during hospitalization
Key Highlights
PWID with IE have higher risk of new IE episodes within 5 years compared to non-PWID (OR 4.65; P = .003).
One-year all-cause mortality is similar between PWID IE (4.0%) and non-PWID IE (4.1%), but 5-year mortality is higher in PWID IE (18.7% vs 13.3%; P = .399).
Injection drug use, female gender, and higher age-adjusted comorbidity index independently predict death during 5-year follow-up.
Guideline-Based Recommendations
Diagnosis
Use modified Duke criteria for possible or definite IE diagnosis.
Classify IE episodes as intravenous drug use–related, community-acquired, or health care–associated based on clinical history and timing.
Management
Provide addiction specialist consultation during hospitalization for PWID with IE (received by 86% of PWID patients).
Offer medications for opioid use disorder (MOUD) before IE onset and at discharge to PWID.
Address ongoing intravenous drug use to reduce risk of recurrent IE.
Monitoring & Follow-up
Follow patients for at least 5 years post-IE episode to monitor survival and recurrence.
Monitor for new IE episodes, especially in PWID, given higher recurrence risk.
Risks
Continued intravenous drug use increases risk of new IE episodes and poorer long-term survival.
Socioeconomic determinants and comorbidities contribute to mortality risk.
Patient & Prescribing Data
PWID with infective endocarditis
16 PWID received MOUD before IE onset; 33 received MOUD at discharge; buprenorphine and amphetamines/stimulants were the most used substances.
Clinical Best Practices
Integrate addiction treatment and specialist consultation during IE hospitalization for PWID.
Implement long-term follow-up strategies to detect and manage recurrent IE episodes.
Consider demographic and comorbidity factors when assessing prognosis and planning care.
Promote MOUD to reduce relapse and improve long-term outcomes.
