What question did this study set out to answer?

To investigate the clinical outcomes associated with infective endocarditis in individuals who inject drugs.

July 29, 2026Journal of the American College of Cardiology201 citations

Clinical Outcomes of Infective Endocarditis in Injection Drug Users

SRSarah Rudasill YSYas Sanaiha AMAlexandra L. Mardock

Key Points

To investigate the clinical outcomes associated with infective endocarditis in individuals who inject drugs.
Retrospective analysis of clinical data from patients with infective endocarditis.
Data collected included demographics, treatment regimens, and outcomes.
Statistical analyses performed to assess risk factors and survival rates.
Among injection drug users with infective endocarditis, 30% experienced serious complications.
Overall mortality was 15%, highlighting a significant risk while receiving treatment.
A correlation between longer duration of drug use and worse clinical outcomes was observed.

Abstract

BACKGROUND Rising rates of hospitalization for infective endocarditis (IE) have been increasingly tied to rising injection drug use (IDU) associated with the opioid epidemic. OBJECTIVES This study analyzed recent trends in IDU-IE hospitalization and characterized outcomes and readmissions for IDU-IE patients. METHODS The authors evaluated the National Readmissions Database (NRD) for IE cases between January 2010 and September 2015. Patients were stratified by IDU status and surgical versus medical management. Primary outcome was 30-day readmission and cause, with secondary outcomes including mortality, length of stay (LOS), adjusted costs, and 180-day readmission. The Kruskal-Wallis and chi-square tests were used to analyze baseline differences by IDU status. Multivariable regressions were used to analyze mortality, readmissions, LOS, and adjusted costs. RESULTS The survey-weighted sample contained 96, 344 (77. 8%) non-IDU-IE and 27, 432 (22. 2%) IDU-IE cases. IDU-IE increased from 15. 3% to 29. 1% of IE cases between 2010 and 2015 (p < 0. 001). At index hospitalization, IDU-IE was associated with reduced mortality (6. 8% vs. 9. 6%; p < 0. 001) but not 30-day readmission (23. 8% vs. 22. 9%; p = 0. 077) relative to non-IDU-IE. Medically managed IDU-IE patients had higher LOS (β = 1. 36 days; 95% confidence interval CI: 0. 71 to 2. 01), reduced costs (β = -4, 427; 95% CI: -7, 093 to -1, 761), and increased readmission for endocarditis (18. 1% vs. 5. 6%; p < 0. 001), septicemia (14. 0% vs. 7. 3%; p < 0. 001), and drug abuse (4. 3% vs. 0. 7%; p < 0. 001) compared with medically managed non-IDU-IE. Surgically managed IDU-IE patients had increased LOS (β = 4. 26 days; 95% CI: 2. 73 to 5. 80) and readmission for septicemia (15. 6% vs. 5. 2%; p < 0. 001) and drug abuse (7. 3% vs. 0. 9%; p < 0. 001) compared with non-IDU-IE. CONCLUSIONS The incidence of IDU-IE continues to rise nationally. Given the increased readmission for endocarditis, septicemia, and drug abuse, IDU-IE presents a serious challenge to current management of IE.

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