Endocarditis in IV Drug Abusers

Document Type : Research Paper

Authors

Abstract

I
 
ntroduction:Intravenous drug use is an increasing social challenge and a predisposing condition to infective endocarditis. Data on infective endocarditis in intravenous drug users in our society are limited. The aim of this study is determining the clinical features, site of involvement and bacteriologic findings of infective endocarditis in intravenous drug users.
 
Materials and Methods: In this descriptive study, injection drug users who admitted at Infectious Diseases Ward, Imam Reza Hospital in a 5 years period (2001-2005), were reviewed and patients characteristics, the results of blood cultures, echocardiographic study, chest imaging and other standard blood testing were collected in questionnaires. Statistical analysis of data was done by SPSS-11 software.
 
Results: A total of 38 cases of infective endocarditis occurred in 34 patients. All of these patients were men with a mean (+/- SD) age of 30.4 +/- 7.1 years. The tricuspid valve was involved in 26 cases (74.3%), the mitral valve in 4 cases (11.4%), the mitral and tricuspid valve in 4 cases (11.4%), and the mitral and aortic valve in 1 case (2.9%). The blood cultures were negative in 28.9% 0f cases; microorganisms identified in positive blood cultures included Staphylococcus aureus (77.8%, MRSA in 33.3% and MSSA in 44.4% of cases), Enterococcus(7.4%), Streptococcus pyogenes (7.4%) and Klebsiella pneumoniae (7.4%). Eight patients (21.1%) underwent surgery, and nine (23.7%) of patients died.
 
Conclusion: Infective endocarditis in intravenous drug users affects the right side of the heart more commonly. Staphylococcus aureus is still the most frequent organism isolated from blood cultures, but the frequency of methicillin resistant staphylococci, organisms with higher resistance to medical therapy, is increasing. Thus, the suggested empirical regimen for the treatment of infectious endocarditis is a combination of cloxacillin, gentamycin and vancomycin. This regimen would be changed on the basis of the results of the blood culture and the pattern of antibiotic susceptibility.

Keywords

References

1- Levine DP, CraneLR, Zervos MJ. Bacteremia in narcotic addicts at the Detroit Medical Center. II. Infectious
endocarditis: A prospective comparative study. Rev Infect Dis 1986; 8:374-396.
2- Chambers HF, Korzeniowski OM, Sande MA. Staphylococcus aureus endocarditis: clinical manifestations in
addicts and nonaddicts. Medicine (Baltimore) 1983; 62(3):170-7.
3- Pazin GJ, Saul S, Thopmson ME. Blood cultures positivity: Suppression by outpatient antibiotic therapy in patients
with bacterial endocarditis. Arch Intern Med 1982; 142:263-268. 
/0120
4- Levine DP, Fromm BS, Reddy BR. Slow response to vancomycin or vancomycin plus rifampin in methicillinresistant
Staphylococcus aureus endocarditis. Ann Intern Med 1991; 115:674-680.
5- Korzeniowski O, Sande MA. Combination antimicrobial therapy for Staphylococcus aureus endocarditis in patients
addicted to parenteral drugs and in nonaddicts. A prospective study. Ann Intern Med 1982; 97:496-503.
6- El-Khatib MR, Wilson FM, Lerner AM. Characteristics of bacterial endocarditis in heroin addicts in Detroit. Am J
Med Sci 1976; 271(2):197-201.
7- Lange M, Salaki JS, Middleton JR, Sen P, Kapila R, Gocke M, et al. Infective endocarditis in heroin addicts:
epidemiological observations and some unusual cases. Am Heart J 1978; 96(2):144-52.
8- Freidlander J, Bouvet E, Witchitz S, Vachon F. Bacterial endocarditis in drug addicts. 20 cases (author's transl).
Nouv Presse Med 1981; 10(37):3045-8.
9- Mathew J, Addai T, Anand A, Morrobel A, Maheshwari P, Freels S. clinical features, site of involvement,
bacteriologic findings, and outcome of infective endocarditis in intravenous drug users. Arch Intern Med 1995;155:
1641-1648.
10- Reiner NE, Gopalakrishna KV, Lerner PI. Enterococcal endocarditis in heroin addicts. JAMA 1976; 235 (17):1861-3.
11- Thomas MG, Rowland-Jones S, Smyth E. Klebsiella pneumoniae endocarditis. J R Soc Med 1989; 82(2):114-5.
12- Kim EL, Ching DL, Pien FD. Bacterial endocarditis at a small community hospital. Am J Med Sci 1990; 229:87-92.
13- Carruthers M. Endocarditis due to enteric bacilli other than Salmonella: Case report and literature review. Am J
Med Sci. 1977; 272:203-7.
14- Faber M, Frimodt-Moller N, Espersen F, Skinhoj P, Rosdahl V. Staphylococcus aureus endocarditis in Danish
intravenous drug users: high proportion of left-sided endocarditis. Scand J Infect Dis 1995; 27(5):483-7.
15- Andy JJ, Ogbuawa OO, Ali N. Staphylococcal endocarditis: clinical observations on 113 patients. Afr J Med Med
Sci 1977; 6(4):177-83.
16- Manolis AS, Melita H. Echocardiographic and clinical correlates in drug addicts with infective endocarditis.
Implications of vegetation size. Arch Intern Med 1988;148(11):2461-5
17- Graves MK, Soto L. Left-sided endocarditis in parenteral drug abusers: Recent experience at a large community
hospital. South Med J 1992; 85:378-380.
18- Brown PD, Levine DP. Infective endocarditis in the injection drug users. Infect Dis Clin North Am 2002, 16:645-
665, viii-ix.
19- Sklaver AR, Hoffman TA, Greenman RL. Staphylococcal endocarditis in addicts. South Med J 1978; 71(6):638-43.
20- Hecht SR, Berger M. Right-sided endocarditis in intravenous drug users: Prognostic features in 102 episodes. Ann
Itern Med 1992; 117:560-566.
21- Mathew J, Abreo G, Namburi K, Narra L, Franklin C. Results of surgical treatment for infective endocarditis in
intravenous drug users. Chest 1995; 108:73-77.
22- Ulanova VI, Tsinzerling VA. Clinical and morphological characteristics of infective endocarditis in HIV-infected
drug addicts. Arkh Patol 2006; 68(3):14-8.
23- Moss R, Munt B. Injection drug use and right sided endocarditis. Heart 2003; 89:577-581.
24- De Rosa FG, Cicalini S, Canta F, Audagnotto S, Cecchi E, Di Perri G. Infective endocarditis in intravenous drug
users from Italy: The increasing importance in HIV-infected patients. Infection 2007; 35(3):154-160.
25- Palepu A, Cheung SS, Montessori V, Woods R, Thompson CR. Factors other than the Duke criteria associated with
infective endocarditis among injection drug users, Clin Invest Med 2002; 25:118-125.
26- Carozza A, De Santo, Romano G, Della Corte A, Ursomando F, Scardone M, et al. Infective endocarditis in
intravenous drug abusers: patterns of presentation and long-term outcomes of surgical treatment. J Heart Valve Dis
2006; 15(1):125-131.
27- Vassiloyanakopoulos A, Falagas ME, Allamani M, Michalopoulos A. Aspergillus fumigatus tricuspid native valve
endocarditis in a non-intravenous drug user. J Medical Microbiol 2006; 55:635-638.
28- Oh S, Havlen PR, Hussain N. A case of polymicrobial endocarditis caused by anaerobic organisms in an injection
drug user. J gen Intern Med 2005; 20(10):C1-2.

medical journal of mashhad university of medical sciences
Volume 51, Issue 1 - Serial Number 1
March and April 2007
Pages 53-60

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