SCIENTIFIC
A Descriptive Study Assessing Temporal Changes in Infective Endocarditis in Huntington , West Virginia , from Years 2010 to 2019
AUTHORS : Kennedy Snavely 1
Brianna Roberts Canales , MD 1 Kendell McNeely , MD 1 Daniel Snavely , MD 2 Todd W . Gress , MD , MPH 3 , 4 Mary Beth Cordle , MS 5 Alfred Cecchetti , PhD , MSc , MSc IS 5 Mehiar El-Hamdani , MD 6
1
Joan C . Edwards School of Medicine , Marshall University
2
Department of Cardiology , St . Mary ’ s Medical Center
3
Research Service , Hershel “ Woody ” Williams VAMC
4
Department of Internal Medicine , Joan C . Edwards School of Medicine , Marshall University
5
Department of Clinical and Translational Science , Joan C . Edwards School of Medicine
6
Department of Cardiovascular Services , Joan C . Edwards School of Medicine , Marshall University
BACKGROUND
Infective endocarditis ( IE ) is an infection of the endocardium , or the inner lining of the heart . 1 Its incidence is difficult to determine due to variations in its definition between clinical centers . 2 Although in-hospital mortality and cost of admission for IE have declined in the United States ( US ) within the past decade , overall hospitalization costs for IE have increased , placing a financial burden on healthcare systems . 3 , 4
Several risk factors increase an individual ’ s susceptibility to IE , including age > 60 years , male sex at birth , injection drug use ( IDU ), poor dentition , and several comorbid conditions , including structural
ABSTRACT
BACKGROUND
The rate of infective endocarditis ( IE ) in persons who inject drugs ( PWID ) has increased concomitantly with injection drug use in the United States . The purpose of this study is to analyze changes in the incidence and characteristics of IE by opioid use in Huntington , West Virginia .
MATERIALS & METHODS
This is a retrospective analysis of electronic medical records for patients 12 years of age and older who were diagnosed with IE and treated within Cabell Huntington Hospital ( CHH ). Opioid use was defined by International Classification of Disease diagnosis and / or a positive toxicology screen .
RESULTS
There were 444 cases with an IE diagnosis admitted to CHH between 2010 and 2019 . Among
heart disease , prosthetic heart valve ( s ), intravascular devices , chronic hemodialysis , and human immunodeficiency virus ( HIV ) infection in the setting of IDU . 2 There are several causal organisms associated with IE , and microbiology can vary by population . 2 The three most common organisms that cause IE globally are Staphylococci , Streptococci , and Enterococci . 2 Staphylococci commonly cause healthcare-associated IE , and Streptococci commonly cause community-associated IE . 2 In the US , Staphylococcus aureus is the most common cause of IE . 2
Transthoracic echocardiography ( TTE ) is the initial imaging test of choice used to confirm IE . 1 Transesophageal echocardiography ( TEE ) can reveal vegetations too small to be seen on TTE and is used when TTE is nondiagnostic or a diagnosis of IE has been made clinically . 1 Right-sided IE refers to cases of IE involving the tricuspid or pulmonic valve . 5 Right-sided IE comprises about 10 % of all IE cases , and concomitant left-sided and right-sided IE accounts for roughly 13 % of all IE cases . 5 these IE cases , 272 patients met our definition of opioid use ( PWID-IE ); 172 patients did not ( non-PWID-IE ). There was a significant increase ( P for trend < 0.001 ) in the number of annual admissions for PWID-IE versus non-PWID-IE between 2010 and 2019 . Using the base year of 2010 , IE cases in the years 2017-2019 were five to 19 times more likely to be due to PWID relative to non-PWID .
CONCLUSIONS
Our findings reveal that annual admissions for IE at CHH have markedly increased throughout the past decade included in the study timeframe . PWID-IE comprised a majority ( 61.3 %) of total IE cases during this time . With the significant increase in PWID-IE , an emphasis should be placed on destigmatizing substance use disorder and improving access to recovery services to improve health outcomes in this vulnerable population .
Risk factors for right-sided IE include IDU , intravascular devices , and presence of an underlying right-sided cardiac condition . 5 About 90 % of all patients with right-sided IE are people who inject drugs ( PWID ); the remaining 10 % of patients are those with intravascular devices ( 9 %) and those with underlying right-sided cardiac conditions ( 1 %). 5 The rate of right-sided IE in PWID has increased concomitantly with the use of heroin in the US between 2006 and 2013 . 5 During this period , right-sided IE in PWID was more commonly seen in younger patients with equal gender distribution . 5
Cases of IE in PWID in the short term tend to have relatively good outcomes , with in-hospital mortality rates reported to be consistently lower than those hospitalized for IE due to other causes . 6 However , longterm morbidity and mortality in PWID with IE ( PWID-IE ) are poor , which is likely multifactorial . 6 PWID are more likely to experience premature death than sameaged individuals who do not use drugs , regardless of whether or not they are diag-
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