Infective endocarditis in persons who use drugs: Epidemiology, current management, and emerging treatments PMC

CSF analysis revealed elevated protein 118 mg/dL, glucose 240 mg/dL with WBC 73 (segment 98%). Physical examination on presentation was significant for temperature of 39.3°C, controlled blood pressure, sinus tachycardia at a rate of 105 beats/min, and a respiratory rate of 28/min. The patient had multiple abscesses on the upper extremities at the sites of IV drug injection. Multiple pink, macular, irregular lesions were seen on the patient’s right thumb and hand (Fig. 1). Moreover, patients whose addictions remain untreated leave the hospital at even higher risk. The spike in cases, and growing recognition that the U.S. health system is ill-equipped to treat complex patients experiencing addiction, has spurred calls for improving treatment standards.

Other drugs that pose a risk

With prompt diagnosis and proper medical treatment, over 90% of patients with bacterial endocarditis recover. Those whose endocarditis affects the right side of the heart tend to have a better outlook than those with left-side involvement. In cases in which endocarditis is caused by fungi, the prognosis is usually iv drug use worse than for bacterial endocarditis. Given clinical and ECHO finding suggestive for infective endocarditis of aortic valve (AV), the cardiology team recommended cardiothoracic surgery evaluation for AV replacement. Intravenous furosemide was started and the patient was prepared for aortic valve replacement.

Safety and feasibility of intravenous sotalol loading for the prevention of ventricular arrhythmias

Baseline characteristics, success of sotalol initiation/loading, changes in heart rate (HR) and QT/QTc, safety, and LOS were compared between patients undergoing sotalol loading/initiation for ventricular arrhythmias (IV vs. PO) and between patients undergoing IV sotalol loading for ventricular arrhythmias vs. for atrial arrhythmias. The development of infectious endocarditis requires the presence of bacteria or fungi in the blood and an intracardiac surface on which these microorganisms can attach. Mechanical and biomechanical prosthetic heart valves can serve as foci for platelet adhesion and thrombus formation. These sites in turn provide extra surface area to which microorganisms can adhere and form vegetations3 (Figure 1). When endocarditis is caused by a bacterial infection, it usually is treated with four to six weeks of antibiotics. The type of antibiotic and the length of therapy depend on the results of the blood cultures.

Cardiovascular Diseases and Cardiac Surgery

However, taking our patient as an example, there comes a need to emphasize a coordinated and systematic multidisciplinary approach to prevent complications and new IE in IVDUs. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. For patients allergic to penicillin, cephalosporins such as cefazolin (6 g/day) or ceftriaxone (1–4 g/day) are generally used if the patient has no history of anaphylactic reactions. Last year, conservative media caused an uproar by falsely reporting that the Biden administration planned to use federal money to distribute sterile pipes used to consume methamphetamine or fentanyl, among other drugs. In response, the White House issued a formal denial — and lawmakers from both parties introduced legislation meant not only to ban the use of federal funds for sterile pipes, but also to prevent government money from being spent, for the first time, on clean syringes. Opioid-use disorder affects more than 2 million people in the United States.

Heart Valves and Infective Endocarditis

Similarly to most examples of IE, Staphylococcus aureus is the causative agent in majority of IE cases (60–70%) related to IDU and is mostly MSSA. However, less common infections including Methicillin resistant staphylococcus aureus (MRSA) (up to 26%), streptococci viridans (8–10%), enterococci (2–5%), streptococci bovis or other streptococci species (3%), coagulase-negative staphylococci (3%), and fungi (1–2%), do occur (6, 7). Coli, Corynebacterium, Proteus mirabilis, Mycobacterium tuberculosis, and Bacteroides fragilis(8).

Infective Endocarditis

• Implementation of harm reduction education in the hospital or helping patients to link to syringe service programs (SSPs) at discharge may help reduce the risk of repeat infections and fatal overdoses.
• In recent years, such cases have engendered frustration from hospitals and additional stigma among health providers — even leading to public debates about whether patients with multiple endocarditis cases are worthy of additional care.
• The initial platelet-fibrin clot provides a nidus for bacterial adherence and further platelet aggregation.
• In about 20% to 40% of patients who do not have artificial heart valves and who do not use intravenous drugs, no heart problem can be identified that would increase their risk of endocarditis.

Infective Endocarditis and Intravenous Drug Users: Never Was and Never Will Be Taken Lightly

• Show this card to your dentist, pediatrician, family doctor or other health care professional.
• Depending on the aggressiveness (virulence) of the infecting germ, the heart damage caused by endocarditis can be swift and severe (acute endocarditis) or slower and less dramatic (subacute endocarditis).
• The authors have not received any funding or benefits from industry or elsewhere to conduct this study.
• Over time, the etiology, as well as causes of IE, have evolved and doubled in numbers because of a greater number of patients with indwelling cardiac devices and central lines.
• Endocarditis occurs when infectious organisms, such as bacteria or fungi, enter the bloodstream and settle in the heart.
• The diagnosis of infectious endocarditis requires multiple clinical, laboratory, and imaging findings.