Clinical Severity and Surgical Burden in Drug Use-Associated Infective Endocarditis: A Six-Year Cohort Study

TL;DR

Drug use-associated infective endocarditis affects younger patients and leads to more severe infections and surgeries compared to non-drug-related cases.

Contribution

This study identifies DUA-IE as a distinct, more aggressive form of infective endocarditis with unique clinical and surgical challenges.

Findings

DUA-IE patients were younger and had higher rates of HIV and hepatitis C coinfections.

DUA-IE was associated with larger vegetations, more complications, longer hospitalizations, and higher in-hospital mortality.

DUA-IE patients required more emergency surgeries despite being younger.

Abstract

Drug use–associated infective endocarditis (DUA-IE) is an increasingly important clinical problem that affects younger patients and poses substantial diagnostic, therapeutic, and surgical challenges. We conducted a retrospective cohort study of adults with definite infective endocarditis treated at a tertiary referral center between 2017 and 2022, comparing patients with DUA-IE to those with non–drug use–associated infective endocarditis. Of the 189 patients, 43 (22.8%) had DUA-IE. These patients were significantly younger and had higher rates of HIV and hepatitis C coinfections. Staphylococcus aureus was the predominant pathogen, and right-sided valve involvement was more frequent; however, left-sided disease predominated among patients requiring valve surgery. Compared with non-DUA-IE patients, those with DUA-IE had larger vegetations, higher inflammatory markers, more frequent complications(including sepsis, embolic events, and heart failure), higher rates of emergency surgical intervention, longer hospitalizations, and increased in-hospital mortality rates. In conclusion, DUA-IE represents a distinct and more aggressive form of infective endocarditis, characterized by severe infection, increased complication rates, and a substantial surgical burden despite the younger patient age, underscoring the need for integrated infectious disease, surgical, and addiction-focused care models for these patients.

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