Clinical Features, Site of Involvement, Bacteriologic Findings, and Outcome of Infective Endocarditis in Intravenous Drug Users

doi:10.1001/archinte.1995.00430150125013

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Vol. 155 No. 15, 7 AUGUST 1995

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Clinical Features, Site of Involvement, Bacteriologic Findings, and Outcome of Infective Endocarditis in Intravenous Drug Users

James Mathew, MD; Theodore Addai, MD; Ashwin Anand, MD; Angel Morrobel, MD; Pradeep Maheshwari, MD; Sally Freels, PhD

Arch Intern Med. 1995;155(15):1641-1648.

Abstract

Background
Intravenous drug use is an increasingly common condition predisposingto infective endocarditis. Data on infective endocarditis inintravenous drug users are limited.

Objective
To determine the clinical features, bacteriologic findings,site of involvement, complications, and mortality associatedwith infective endocarditis in intravenous drug users.

Methods
Cohort study of intravenous drug users with native valve infectiveendocarditis.

Results
A total of 125 cases of infective endocarditis occurred in 114patients (84 cases [67%] in men and 41 cases [32%] in women)with a mean (±SD) age of 37±7 years. The tricuspidvalve was involved in 58 cases (46%), the mitral valve in 40cases (32%), and the aortic valve in 24 cases (19%). The microorganismsidentified included Staphylococcus in 82 cases (65.6%) and Streptococcusin 32 cases (25.6%). Twenty-three patients (18%) underwent surgery,and two (9%) of them died. One hundred two patients (82%) weretreated medically, and nine (9%) of them died. Fifteen patients(63%) with aortic valve involvement vs 17 patients (17%) withoutaortic valve involvement underwent surgery or died without surgery(odds ratio, 8.24; 95% confidence interval, 3.1 to 21.8). Amongthe survivors, at least one major cardiovascular complicationoccurred in 79 cases (69.3%).

Conclusions
Infective endocarditis in intravenous drug users affects theright and left sides of the heart with approximately equal frequency.At present, more than 90% of cases of infective endocarditisin intravenous drug users in Chicago are caused by staphylococcior streptococci. Involvement of the aortic valve is predictiveof increased morbidity and mortality in intravenous drug userswith infective endocarditis. With medical treatment, and surgerywhen medical treatment fails, intravenous drug users with infectiveendocarditis have an in-hospital survival rate of 91%.

(Arch Intern Med. 1995;155:1641-1648)

Author Affiliations

From the Division of Adult Cardiology, Department of Medicine, Cook County Hospital, Chicago, Ill (Drs Mathew, Addai, Anand, Morrobel, and Maheshwari); the Department of Medicine, University of Illinois at Chicago (Dr Mathew); and the Department of Biostatistics, School of Public Health, University of Chicago (Dr Freels).

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