Mortality, morbidity, and cardiac surgery in Injection Drug Use (IDU)-associated versus non-IDU infective endocarditis: The need to expand substance use disorder treatment and harm reduction services

English version

Autoři: Kinna Thakarar ^aff001; Kristina E. Rokas ^aff003; F. L. Lucas ^aff001; Spencer Powers ^aff003; Elizabeth Andrews ^aff003; Christina DeMatteo ^aff003; Deirdre Mooney ^aff002; Marcella H. Sorg ^aff005; August Valenti ^aff002; Mylan Cohen ^aff001
Působiště autorů: Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME, United States of America ^aff001; Tufts University School of Medicine, Boston, MA, United States of America ^aff002; Maine Medical Center, Portland, ME, United States of America ^aff003; InterMed Infectious Disease, South Portland, ME, United States of America ^aff004; Margaret Chase Smith Policy Center, University of Maine, Orono, ME, United States of America ^aff005
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0225460

Souhrn

Background

The addiction crisis is widespread, and unsafe injection practices among people who inject drugs (PWID) can lead to infective endocarditis.

Methods

A retrospective analysis of adult patients with definite or possible infective endocarditis admitted to a tertiary care center in Portland, Maine was performed over three-year period. Our primary objective was to examine differences in demographics, health characteristics, and health service utilization between injection drug use (IDU)-associated infective endocarditis and non-IDU infective endocarditis. The association between IDU and mortality, morbidity (defined as emergency department visits within 3 months of discharge), and cardiac surgery was examined. Bivariate and multivariate analyses were performed. A subgroup descriptive analysis of PWID was also performed to better examine substance use disorder (SUD) characteristics, treatment with medication for opioid use disorder (MOUD) and health service utilization.

Results

One-hundred and seven patients were included in the study, of which 39.2% (n = 42) had IDU-associated infective endocarditis. PWID were more likely to be homeless, uninsured, and lack a primary care provider. PWID were notably younger and had less documented comorbidities, however had similar in-hospital mortality rates (10% vs. 14%, p = 0.30), ED visits (50% vs. 54%, p = 0.70) and cardiac surgery (33% vs. 26%, p = 0.42) compared to those with non-IDU infective endocarditis. Ninety-day mortality was less among PWID (19.0% vs. 36.9%, p = 0.05). IDU was not associated with morbidity (adjusted odds ratio (AOR) 0.73, 95% CI 0.18–3.36), 90-day mortality (AOR 0.72, 95% CI 0.17–3.01), or cardiac surgery (AOR 0.15, 95% CI 0.03–0.69). Ninety-day mortality among PWID who received MOUD was lower (3% vs 15%, p = 0.45), as were ED visits (10% vs. 41%, p = 0.42) compared to those who did not receive MOUD.

Conclusions

Our results highlight existing differences in health characteristics and social determinants of health in people with IDU-associated versus non-IDU infective endocarditis. PWID had less comorbidities and were significantly younger than those with non-IDU infective endocarditis and yet still had similar rates of cardiac surgery, ED visits, and in-hospital mortality. These findings emphasize the need to deliver comprehensive health services, particularly MOUD and other harm reduction services, to this marginalized population.

Klíčová slova:

Behavioral and social aspects of health – Cardiac surgery – Critical care and emergency medicine – Death rates – Endocarditis – Morbidity – Opioids – Staphylococcal infection

Zdroje

1. Ebright JR, Pieper B. Skin and soft tissue infections in injection drug users. Infect Dis Clin North Am. 2002;16(3):697–712. doi: 10.1016/s0891-5520(02)00017-x 12371123.

2. Centers for Disease C, Prevention. Pseudomonas aeruginosa respiratory tract infections associated with contaminated ultrasound gel used for transesophageal echocardiography—Michigan, December 2011-January 2012. MMWR Morbidity and mortality weekly report. 2012;61:262–4. 22513528.

3. Moss R, Munt B. Injection drug use and right sided endocarditis. Heart. 2003;89(5):577–81. doi: 10.1136/heart.89.5.577 12695478; PubMed Central PMCID: PMC1767660.

4. Wurcel AG, Anderson JE, Chui KK, Skinner S, Knox TA, Snydman DR, et al. Increasing Infectious Endocarditis Admissions Among Young People Who Inject Drugs. Open Forum Infect Dis. 2016;3(3):ofw157. doi: 10.1093/ofid/ofw157 27800528; PubMed Central PMCID: PMC5084714.

5. Zibbell JE, Iqbal K, Patel RC, Suryaprasad A, Sanders KJ, Moore-Moravian L, et al. Increases in hepatitis C virus infection related to injection drug use among persons aged </ = 30 years—Kentucky, Tennessee, Virginia, and West Virginia, 2006–2012. MMWR Morbidity and mortality weekly report. 2015;64(17):453–8. 25950251.

6. HRSA. List of Rural Countes and Designated Eligible Census Tracts in Metropolitan Areas.2010 2010 [cited 2017 September 22]. Available from: https://www.hrsa.gov/ruralhealth/resources/forhpeligibleareas.pdf.

7. Services MDoHaH. Substance Abuse Trends in Maine: State Epidemiological Profile 2015. 2015.

8. Rudd RA, Seth P, David F, Scholl L. Increases in Drug and Opioid-Involved Overdose Deaths—United States, 2010–2015. MMWR Morbidity and mortality weekly report. 2016;65(5051):1445–52. doi: 10.15585/mmwr.mm655051e1 28033313.

9. Prevention MCfDCa. Reportable Infectious Diseases Summary. 2016.

10. HealthInfoNet [cited 2018 May 4]. Available from: http://hinfonet.org/about-us/.

11. Li JS, Sexton DJ, Mick N, Nettles R, Fowler VG Jr., Ryan T, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America. 2000;30(4):633–8. doi: 10.1086/313753 10770721.

12. Baddour LM, Wilson WR, Bayer AS, Fowler VG Jr., Tleyjeh IM, Rybak MJ, et al. Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association. Circulation. 2015;132(15):1435–86. doi: 10.1161/CIR.0000000000000296 26373316.

13. Administration HRaS. Defining Rural Population [cited 2016 November]. Available from: https://www.hrsa.gov/rural-health/about-us/definition/index.html.

14. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83. doi: 10.1016/0021-9681(87)90171-8 3558716.

15. Centers for Disease C, Prevention. Notes from the field: risk factors for hepatitis C virus infections among young adults—Massachusetts, 2010. MMWR Morbidity and mortality weekly report. 2011;60(42):1457–8. Epub 2011/10/28. 22031220.

16. Leahey PA, LaSalvia MT, Rosenthal ES, Karchmer AW, Rowley CF. High Morbidity and Mortality Among Patients With Sentinel Admission for Injection Drug Use-Related Infective Endocarditis. Open Forum Infect Dis. 2019;6(4):ofz089. doi: 10.1093/ofid/ofz089 30949535; PubMed Central PMCID: PMC6441563.

17. Gray ME, Rogawski McQuade ET, Scheld WM, Dillingham RA. Rising rates of injection drug use associated infective endocarditis in Virginia with missed opportunities for addiction treatment referral: a retrospective cohort study. BMC Infect Dis. 2018;18(1):532. doi: 10.1186/s12879-018-3408-y 30355291; PubMed Central PMCID: PMC6201507.

18. Thakarar K, Weinstein ZM, Walley AY. Optimising health and safety of people who inject drugs during transition from acute to outpatient care: narrative review with clinical checklist. Postgrad Med J. 2016;92(1088):356–63. doi: 10.1136/postgradmedj-2015-133720 27004476; PubMed Central PMCID: PMC4967553.

19. Prevention MCfDCa. Acute Hepatitis B: Maine Surveillance Report 2017 2017 [cited 2018 September 19]. Available from: https://www.maine.gov/dhhs/mecdc/infectious-disease/epi/hepatitis/documents/2017-HBV-Acute-Surveillance-Report.pdf.

20. Prevention CfDCa. STD Diagnoses Among Key U.S. Populations, 5-year Trends 2018 [cited 2018 September 19]. Available from: https://www.cdc.gov/nchhstp/newsroom/docs/2018/table-data-2018-STD-Prevention-Conference.pdf.

21. Aidala A, Cross JE, Stall R, Harre D, Sumartojo E. Housing status and HIV risk behaviors: implications for prevention and policy. AIDS and behavior. 2005;9(3):251–65. doi: 10.1007/s10461-005-9000-7 16088369.

22. Linton SL, Celentano DD, Kirk GD, Mehta SH. The longitudinal association between homelessness, injection drug use, and injection-related risk behavior among persons with a history of injection drug use in Baltimore, MD. Drug and alcohol dependence. 2013;132(3):457–65. doi: 10.1016/j.drugalcdep.2013.03.009 23578590; PubMed Central PMCID: PMC3926693.

23. Jones CM. Trends and key correlates of prescription opioid injection misuse in the United States. Addictive behaviors. 2018;78:145–52. doi: 10.1016/j.addbeh.2017.10.018 29175290.

24. Eaton EF, Mathews RE, Lane PS, Paddock CS, Rodriguez JM, Taylor BB, et al. A 9-Point Risk Assessment for Patients Who Inject Drugs and Require Intravenous Antibiotics: Focusing Inpatient Resources on Patients at Greatest Risk of Ongoing Drug Use. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America. 2019;68(6):1041–3. doi: 10.1093/cid/ciy722 30165395.

25. Iversen K, Ihlemann N, Gill SU, Madsen T, Elming H, Jensen KT, et al. Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis. The New England journal of medicine. 2018. doi: 10.1056/NEJMoa1808312 30152252.

26. Thakarar K, Morgan JR, Gaeta JM, Hohl C, Drainoni ML. Predictors of Frequent Emergency Room Visits among a Homeless Population. PloS one. 2015;10(4):e0124552. doi: 10.1371/journal.pone.0124552 25906394; PubMed Central PMCID: PMC4407893.

27. Choo EK, Beauchamp G, Beaudoin FL, Bernstein E, Bernstein J, Bernstein SL, et al. A research agenda for gender and substance use disorders in the emergency department. Academic emergency medicine: official journal of the Society for Academic Emergency Medicine. 2014;21(12):1438–46. doi: 10.1111/acem.12534 25444022; PubMed Central PMCID: PMC4318812.

28. Rabkin DG, Mokadam NA, Miller DW, Goetz RR, Verrier ED, Aldea GS. Long-term outcome for the surgical treatment of infective endocarditis with a focus on intravenous drug users. Ann Thorac Surg. 2012;93(1):51–7. doi: 10.1016/j.athoracsur.2011.08.016 22054655.

29. 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. Archives of internal medicine. 1995;155(15):1641–8. 7618988.

30. Hecht SR, Berger M. Right-sided endocarditis in intravenous drug users. Prognostic features in 102 episodes. Annals of internal medicine. 1992;117(7):560–6. doi: 10.7326/0003-4819-117-7-560 1524330.

31. Rieg S, Peyerl-Hoffmann G, de With K, Theilacker C, Wagner D, Hubner J, et al. Mortality of S. aureus bacteremia and infectious diseases specialist consultation—a study of 521 patients in Germany. J Infect. 2009;59(4):232–9. doi: 10.1016/j.jinf.2009.07.015 19654021.

32. Fowler VG Jr., Sanders LL, Sexton DJ, Kong L, Marr KA, Gopal AK, et al. Outcome of Staphylococcus aureus bacteremia according to compliance with recommendations of infectious diseases specialists: experience with 244 patients. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America. 1998;27(3):478–86. doi: 10.1086/514686 9770144.

33. Jenkins TC, Price CS, Sabel AL, Mehler PS, Burman WJ. Impact of routine infectious diseases service consultation on the evaluation, management, and outcomes of Staphylococcus aureus bacteremia. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America. 2008;46(7):1000–8. doi: 10.1086/529190 18444816.

34. Honda H, Krauss MJ, Jones JC, Olsen MA, Warren DK. The value of infectious diseases consultation in Staphylococcus aureus bacteremia. The American journal of medicine. 2010;123(7):631–7. doi: 10.1016/j.amjmed.2010.01.015 20493464; PubMed Central PMCID: PMC3606273.

35. Rosenthal ES, Karchmer AW, Theisen-Toupal J, Castillo RA, Rowley CF. Suboptimal Addiction Interventions for Patients Hospitalized with Injection Drug Use-Associated Infective Endocarditis. The American journal of medicine. 2016;129(5):481–5. doi: 10.1016/j.amjmed.2015.09.024 26597670.

36. Clemans-Cape L AE, Basurto L, Lawrence D, Kenney GM. Leveraging Medicaid to Address Opioid and Substance Use Disorders in Maine: Urban Institute; 2019 [cited 2019 September]. Available from: https://www.urban.org/sites/default/files/publication/100443/2019.06.20_mainecare_report_final_7.pdf.

37. Marks LR, Munigala S, Warren DK, Liang SY, Schwarz ES, Durkin MJ. Addiction Medicine Consultations Reduce Readmission Rates for Patients With Serious Infections From Opioid Use Disorder. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America. 2019;68(11):1935–7. doi: 10.1093/cid/ciy924 30357363; PubMed Central PMCID: PMC6522678.

38. Health MDo. Clinical Advisory 2018 [cited 2018 September 19]. Available from: https://www.mass.gov/files/documents/2018/08/16/Clinical%20Advisory%20on%20Opioid%20Deaths-%20HPL%20%26%20BSAS.PDF.

39. Clinical Advisory [Internet]. 2018 [cited August 16, 2018]. Available from: https://www.mass.gov/files/documents/2018/08/16/Clinical%20Advisory%20on%20Opioid%20Deaths-%20HPL%20%26%20BSAS.PDF

40. Ronan MV, Herzig SJ. Hospitalizations Related To Opioid Abuse/Dependence And Associated Serious Infections Increased Sharply, 2002–12. Health Aff (Millwood). 2016;35(5):832–7. doi: 10.1377/hlthaff.2015.1424 27140989; PubMed Central PMCID: PMC5240777.

Mortality, morbidity, and cardiac surgery in Injection Drug Use (IDU)-associated versus non-IDU infective endocarditis: The need to expand substance use disorder treatment and harm reduction services

Souhrn

Background

Methods

Results

Conclusions

Klíčová slova:

Zdroje

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