695 - Infective endocarditis in people who inject drugs (PWID) at UK Medical Center

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Presenting Author(s)

Evelyn B. Villacorta Cari

Infectious Diseases Fellow
UK
Lexington, Kentucky
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

John T. Henderson

Medical Student
University of Kentucky College of Medicine
Lexington, Kentucky
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
DB

Donna R. Burgess

Pharmacist
UK HealthCare
Lexington, KY
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
JP

J. Zachary Porterfield

Assistant Professor
University of Kentucky College of Medicine
Lexington, Kentucky
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
NL

Nicole Leedy

Assistant Professor
University of Kentucky
Lexington, KY
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Alice C. Thornton

Professor
The University of Kentucky
Lexington, Kentucky
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: The Intravenous Drug Use (IVDU) epidemic has been developing into a public health crisis in the last twenty years. As a result, the incidence of severe bacterial infections such as infective endocarditis (IE) has been rising dramatically.

Methods: Cross-sectional study, we reviewed records of all admissions to University of Kentucky hospitals with IVDU associated ICD9/10 codes who received an Infectious Diseases consult during 2018 and focused on the cases with a diagnosis of IE. We describe associated epidemiologic, clinical, and microbiological features

Results: We include 391 patients in this cohort, among those 157 patients were for IE. Patients had a median age of 34 years old (range: 20 - 62); 81 (51.5%) were female, and five (6.1%) were pregnant and 153 (97.4%) identified as white. A previous episode of infective endocarditis was reported in 55 (35%) cases. The most common illicit substances used were heroin 68 (43.3%) and methamphetamine 65 (41.45%). Tobacco abuse was reported in 134 (86.4%) cases. Fever reported in 93 (59.8%) cases, shortness of air in 43 (28.0%) cases, and chest pain in 44 (28.6%) cases were the most common symptoms. Hepatitis C antibody was positive in 115/149 (73.2%) and 3/143 (1.9%) were HIV positive. Right-sided IE was more frequent, the tricuspid valve was involved in 94 (59.8%) patients. Gram-positive pathogens were isolated in 139 (88.5%) patients, Staphylococcus aureus was isolated in 102 (64.9%) patients, of which 67 (65.7%) were methicillin resistant. Gram-negative pathogens were isolated in 18 (11.2%) patients. Eighty-eight (56.4%) patients had an addiction medicine consult during their admission, (22.9%) patients left against medical advice and 20 (12.7%) patients needed to be readmitted within 30 days after discharge. Overall mortality was 12.7% and was significantly associated with infection by gram-negative pathogens (RR: 2.5; CI 95% 1.05 – 6.25, p=0.037).

Conclusion: Infectious endocarditis is a frequent complication in PWID which carries a high risk of mortality and often involves the tricuspid valve. The most common pathogen isolated was S. aureus, isolation of gram-negative pathogens was associated with increased mortality.