Oda Bratland Østerdal1, Pirjo-Riitta Salminen2, Stina Jordal3, Haakon Sjursen4, Øystein Wendelbo3, Rune Haaverstad5. 1. Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway. 2. Section of Cardiothoracic Surgery, Department of Heart Disease, Haukeland University Hospital, Bergen, Norway. 3. Section of Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway. 4. Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway Section of Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway. 5. Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway Section of Cardiothoracic Surgery, Department of Heart Disease, Haukeland University Hospital, Bergen, Norway rune.haaverstad@helse-bergen.no.
Abstract
OBJECTIVES: Intravenous drug users have a high risk of infective endocarditis and reduced survival. Cardiac surgery may be recommended for these patients, but redo surgery is controversial. This study describes the characteristics and outcomes of intravenous drug users accepted for surgery during a 12-year period. METHODS: This retrospective study included 29 injecting drug users treated with valve surgery for endocarditis between January 2001 and December 2013 at a tertiary academic centre. Survival was assessed by Kaplan-Meier analysis. RESULTS: The median patient age was 36 (24-63) years and 27 patients (93%) were male. Staphylococcus aureus (52%) and Enterococcus faecalis (17%) were the most common microorganisms. Common illicit drugs were opioids (69%), amphetamines (52%) and benzodiazepines (24%). Mixed abuse was reported in 66% of patients. Seven patients (24%) had prior intracardial implants or native valve pathology. Twenty-five patients (86%) were positive for hepatitis C virus antibody, but none carried the human immunodeficiency virus. Twelve (41%) were homeless and 15 (52%) had poor dental hygiene. Three patients (10%) received medication-assisted rehabilitation before surgery. The main indications for surgery were regurgitation and secondary heart failure (86%), embolization (41%) and uncontrolled infection (24%). Aortic valve replacement was performed in 24 patients (83%), either as part of univalvular or multiple valve surgery. Seven patients (24%) had multivalvular endocarditis. All but 3 patients received biological valve prostheses. The 30-day mortality was 7% after first time surgery. During follow-up, 15 patients (52%) presented with reinfection: 10 (35%) were offered a second and 2 (7%) a third operation. Thirty-day mortality was 10% after redo surgery. Thirteen patients (45%) died within a median of 22 (0-84) months. Continued intravenous drug use was reported in 70 and 44% of patients after the first and second operation, respectively. CONCLUSIONS: Cardiac surgery for infective endocarditis has acceptable early postoperative results among intravenous drug users. The 2- and 5-year survival were 79 and 59%, respectively. The number of reinfections was high within 2 years, as continued drug use seems to be a major challenge for this group.
OBJECTIVES: Intravenous drug users have a high risk of infective endocarditis and reduced survival. Cardiac surgery may be recommended for these patients, but redo surgery is controversial. This study describes the characteristics and outcomes of intravenous drug users accepted for surgery during a 12-year period. METHODS: This retrospective study included 29 injecting drug users treated with valve surgery for endocarditis between January 2001 and December 2013 at a tertiary academic centre. Survival was assessed by Kaplan-Meier analysis. RESULTS: The median patient age was 36 (24-63) years and 27 patients (93%) were male. Staphylococcus aureus (52%) and Enterococcus faecalis (17%) were the most common microorganisms. Common illicit drugs were opioids (69%), amphetamines (52%) and benzodiazepines (24%). Mixed abuse was reported in 66% of patients. Seven patients (24%) had prior intracardial implants or native valve pathology. Twenty-five patients (86%) were positive for hepatitis C virus antibody, but none carried the human immunodeficiency virus. Twelve (41%) were homeless and 15 (52%) had poor dental hygiene. Three patients (10%) received medication-assisted rehabilitation before surgery. The main indications for surgery were regurgitation and secondary heart failure (86%), embolization (41%) and uncontrolled infection (24%). Aortic valve replacement was performed in 24 patients (83%), either as part of univalvular or multiple valve surgery. Seven patients (24%) had multivalvular endocarditis. All but 3 patients received biological valve prostheses. The 30-day mortality was 7% after first time surgery. During follow-up, 15 patients (52%) presented with reinfection: 10 (35%) were offered a second and 2 (7%) a third operation. Thirty-day mortality was 10% after redo surgery. Thirteen patients (45%) died within a median of 22 (0-84) months. Continued intravenous drug use was reported in 70 and 44% of patients after the first and second operation, respectively. CONCLUSIONS: Cardiac surgery for infective endocarditis has acceptable early postoperative results among intravenous drug users. The 2- and 5-year survival were 79 and 59%, respectively. The number of reinfections was high within 2 years, as continued drug use seems to be a major challenge for this group.
Authors: J S Li; D J Sexton; N Mick; R Nettles; V G Fowler; T Ryan; T Bashore; G R Corey Journal: Clin Infect Dis Date: 2000-04-03 Impact factor: 9.079
Authors: Sowmya Ramanan; Nicolas Doll; Dietmar Boethig; Nadir Tafer; Alexander Horke; Xavier Roques; Wolfgang Bruno Hemmer; François Roubertie Journal: Ann Thorac Surg Date: 2015-07-22 Impact factor: 4.330
Authors: Vivian H Chu; Daniel J Sexton; Christopher H Cabell; L Barth Reller; Paul A Pappas; Rakesh K Singh; Vance G Fowler; G Ralph Corey; Olcay Aksoy; Christopher W Woods Journal: Clin Infect Dis Date: 2005-06-14 Impact factor: 9.079
Authors: David G Rabkin; Nahush A Mokadam; Donald W Miller; Raymond R Goetz; Edward D Verrier; Gabriel S Aldea Journal: Ann Thorac Surg Date: 2011-11-04 Impact factor: 4.330
Authors: Scott P Kaiser; Spencer J Melby; Andreas Zierer; Richard B Schuessler; Marc R Moon; Nader Moazami; Michael K Pasque; Charles Huddleston; Ralph J Damiano; Jennifer S Lawton Journal: Ann Thorac Surg Date: 2007-01 Impact factor: 4.330
Authors: Matthew K Y Tung; Melanie Light; Rinky Giri; Stephen Lane; Alan Appelbe; Craig Harvey; Eugene Athan Journal: Drug Alcohol Rev Date: 2014-12-29
Authors: David R Murdoch; G Ralph Corey; Bruno Hoen; José M Miró; Vance G Fowler; Arnold S Bayer; Adolf W Karchmer; Lars Olaison; Paul A Pappas; Philippe Moreillon; Stephen T Chambers; Vivian H Chu; Vicenç Falcó; David J Holland; Philip Jones; John L Klein; Nigel J Raymond; Kerry M Read; Marie Francoise Tripodi; Riccardo Utili; Andrew Wang; Christopher W Woods; Christopher H Cabell Journal: Arch Intern Med Date: 2009-03-09
Authors: Alec Vahanian; Ottavio Alfieri; Felicita Andreotti; Manuel J Antunes; Gonzalo Barón-Esquivias; Helmut Baumgartner; Michael Andrew Borger; Thierry P Carrel; Michele De Bonis; Arturo Evangelista; Volkmar Falk; Bernard Lung; Patrizio Lancellotti; Luc Pierard; Susanna Price; Hans-Joachim Schäfers; Gerhard Schuler; Janina Stepinska; Karl Swedberg; Johanna Takkenberg; Ulrich Otto Von Oppell; Stephan Windecker; Jose Luis Zamorano; Marian Zembala Journal: Eur J Cardiothorac Surg Date: 2012-08-25 Impact factor: 4.191
Authors: Lucy E Wilson; David L Thomas; Jacqueline Astemborski; Terri L Freedman; David Vlahov Journal: J Infect Dis Date: 2002-05-31 Impact factor: 5.226
Authors: Krish C Dewan; Karan S Dewan; Jay J Idrees; Suparna M Navale; Brad F Rosinski; Lars G Svensson; A Marc Gillinov; Douglas R Johnston; Faisal Bakaeen; Edward G Soltesz Journal: JAMA Surg Date: 2019-03-01 Impact factor: 14.766
Authors: P Alexander Leahey; Mary T LaSalvia; Elana S Rosenthal; Adolf W Karchmer; Christopher F Rowley Journal: Open Forum Infect Dis Date: 2019-03-01 Impact factor: 3.835
Authors: David Goodman-Meza; Robert E Weiss; Sebastián Gamboa; Abel Gallegos; Alex A T Bui; Matthew B Goetz; Steven Shoptaw; Raphael J Landovitz Journal: BMC Infect Dis Date: 2019-11-08 Impact factor: 3.090
Authors: Megan E Gray; Elizabeth T Rogawski McQuade; W Michael Scheld; Rebecca A Dillingham Journal: BMC Infect Dis Date: 2018-10-24 Impact factor: 3.090