709 - Multidisciplinary Drug Use Endocarditis Team (DUET): Results From an Academic Center Cohort

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Presenting Author(s)

Darshali A. Vyas

Resident Physician
Massachusetts General Hospital
Cambridge, Massachusetts
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

LM

Lucas Marinacci

Instructor of Medicine
Massachusetts General Hospital
Dorchester, Massachusetts
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
TS

Thoralf Sundt

Professor of Surgery
Massachusetts General Hospital
Boston, Massachusetts
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
AJ

Arminder Jassar

Dr.
Massachusetts General Hospital, Harvard Medical School
Boston, Massachusetts
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
BB

Benjamin Bearnot

Physician Researcher
Massachusetts General Hospital
Boston, Massachusetts
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
VT

Virginia A. Triant

Assistant Professor
MGH
Boston, MA
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Sandra B. Nelson

Director, Musculoskeletal Infectious Disease and OPAT Programs
Massachusetts General Hospital
Boston, MA
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
SW

Sarah E. Wakeman

Medical Director
Massachussetts General Hospital
Boston, Massachusetts
Disclosure: Celero Systems (Advisor or Review Panel member)Optum Labs (Grant/Research Support)UpToDate (Other Financial or Material Support, Author)
DD

David M. Dudzinski

CICU Director
Massachusetts General Hospital
Boston, Massachusetts
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Molly L. Paras

Fellowship Program Director, Assistant Professor
Massachusetts General Hospital, Harvard Medical School
Boston, MA
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: Guidelines recommend multidisciplinary models for the management of infective endocarditis but have failed to incorporate the unique challenges of treating drug-use associated infective endocarditis (DUA-IE). Given the drug use and overdose epidemic with rising cases of DUA-IE, we created a multidisciplinary Drug Use Endocarditis Team (DUET), which convened monthly case conferences among the specialties involved, including Infectious Diseases, Cardiothoracic Surgery, Cardiology and Addiction Medicine.

Objective: To conduct a retrospective cohort study of the patients presented at the DUET conferences from August 2018 to February 2020 to (1) assess clinical and demographic characteristics and (2) describe clinical outcomes.

Methods: A retrospective chart review was conducted to analyze 57 patient cases, including descriptive statistical analyses of demographics, clinical characteristics, and outcomes.

Results: Among our DUET cohort, 43.8% represented isolated right-sided endocarditis, and 84% involved native valve. Methicillin-susceptible Staphylococcus aureus was the most common microorganism isolated. ID was consulted in 94.7% of cases and overall 43.9% completed the planned antimicrobial course. The 7 patients who developed relapse/recurrent IE were initially managed medically, and 5 did not complete the initial antimicrobial course. Formal cardiothoracic surgery consultation was obtained in 57.9% and 24.6% were managed operatively. Of the patients managed operatively, 64.3% completed the antimicrobial course. The rate of antibiotic completion was higher among patients managed operatively but did not reach statistical significance (p=0.08). Formal addiction medicine consultation was obtained in 85.9% of cases, with 63.1% discharged on medications for opioid use disorder (MOUD). The rate of MOUD on discharge was not significantly different between patients managed operatively and non-operatively.Figure 1: Patient Characteristics

Figure 2: Infection Characteristics

Figure 3: Outcome Analyses

Conclusion: ID is nearly universally involved in the care of patients with DUA-IE, but this patient population requires input from numerous sub-specialties. Multidisciplinary care teams provide a promising framework for DUA-IE to enhance and integrate nuanced decision-making.