# Infective Endocarditis Associated With Intravenous Drug Use: Clinical Course, Biological Characteristics, and Outcomes of a Romanian Cohort

## TL;DR

This study examines infective endocarditis in Romanian drug users, highlighting its severe outcomes and high mortality despite treatment.

## Contribution

The study provides new insights into the clinical and biological features of drug-related endocarditis in Eastern Europe.

## Key findings

- Most patients were young men with HIV and hepatitis C, showing severe co-infections.
- Staphylococcus aureus was the most common pathogen, and over half experienced embolic complications.
- Hospital mortality was 17.5%, with 35% dying within one year, indicating poor long-term outcomes.

## Abstract

Background

Injection drug use is causing a wave of infective endocarditis (IE) worldwide, a severe and potentially deadly infection of the heart’s endothelium. While this important public health problem has been well described in Western countries, available data from Eastern Europe are quite limited. Our study set out to describe this particular patient profile and its background, the clinical course of IE in this population, and evolution during and after hospitalization in a major infectious disease hospital in Bucharest, Romania.

Methodology

We reviewed the patient records of 57 people who inject drugs (PWID) admitted with IE between August 2019 and July 2025. Clinical, microbiological, and outcome data were collected and analyzed using standard descriptive statistics.

Results

The patients were mostly young men with a median age of 34 years. Most of these patients used heroin and other psychoactive substances and faced severe chronic co-infections: 63% were human immunodeficiency virus-positive, and 98% had hepatitis C. Most patients presented to the hospital with fever, malaise, and respiratory symptoms. Echocardiography confirmed valvular vegetations in over 90% of cases, most frequently on the tricuspid valve. Blood cultures were positive in 70%, most often revealing Staphylococcus aureus bacteriemia. More than half had embolic complications, 30% needed intensive care, and a quarter were candidates for cardiovascular surgery. The median hospital stay was 28 days, while mortality remained high at 17.5% during hospitalization and 35% at one year.

Conclusions

IE among PWID represents a life-threatening illness, particularly affecting young adults with multiple infections and comorbidities who are additionally burdened with social challenges. Despite prolonged hospitalizations and intensive care, their short- and long-term outcomes remain unfavorable.