Injection Drug Use-Related Infective Endocarditis is Increasing and Associated With Poor Patient Outcomes

The incidence of hospitalizations related to opioid use disorder (OUD) and medical complications such as injection drug use-related infective endocarditis (IDU-IE) have been increasing over the last twenty years. This large retrospective cohort study of patients hospitalized in Pennsylvania for infective endocarditis sought to describe the hospital length of stay, hospital charges, and insurance status of patients with IDU-IE versus non-IDU-IE.

  • Over a 4-year period, 17,224 patients were hospitalized for infective endocarditis; of these, 1921 (11%) had IDU-IE.
  • Total hospital admissions for infective endocarditis increased, but IDU-IE admissions increased by 238%, compared with 7% for non-IDU-IE admissions.
  • Patients with IDU-IE were more likely to have Medicaid insurance, have higher hospital charges, and less likely to complete the recommended hospital course (i.e., leave against medical advice), compared with patients with non-IDU-IE.

Comments: This study shows dramatic increases in rates of IDU-IE in Pennsylvania, mirroring national trends. The high rates of patients leaving the hospital without treatment suggests that current systems are not adequately equipped to provide essential, evidence-based medication treatments such as buprenorphine and methadone for this complex patient population. A limitation of this study is that it did not confirm substance route of administration and identified patients’ substance use via ICD-10 codes, which likely underestimates the extent of the problem.

Melissa Weimer, DO, MCR

Reference: Meisner JA, Anesi J, Chen X, Grande D. Changes in infective endocarditis admissions in Pennsylvania during the opioid epidemic. Clin Infect Dis. 2019. pii: ciz1038.

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