Clinical Features and Outcomes of Infective Endocarditis in Addicts and Non-Addicts

Abstract

Background: The prevalence of infective endocarditis has markedly increased in Egyptian population especially among intravenous drug addicts. Studies that link infective endocarditis and injection of drugs as a problematic social cause in our population still scarce and query and up to our knowledge this is the first study to discuss the clinical features and outcomes of infective endocarditis in addicts and non-addicts in our population.

Aim:  To highlight on the features and outcomes of infective endocarditis in our Egyptian population especially in addict people.

Patients and methods: According to the modified Duke criteria, individuals who were diagnosed with "definite infective endocarditis" at the cardiology department of Zagazig University Hospital and the National Heart Institute were included in this observational cohort study. Patients were classified into two groups: group I: injection drug use-related infective endocarditis (IDU-IE) and group II: non-injection drug use-related infective endocarditis (Non IDU-IE). Clinical features and outcomes were evaluated.

Results: IDU-IE patients were significantly younger in age than those with non-IDU-IE with a statistically significant male gender predominance. S. aureus, fungal and polymicrobial infections were more significantly associated with IDU-IE patients. IDU-IE patients had a statistically significant longer hospital-stay, utilized a statistically significant more total number of antibiotics with longer duration of treatment and received a statistically significant less rates of cardiac surgery. The in-hospital, out-hospital and over-all mortality (in-hospital and out-hospital) was found to be significantly higher in IDU-IE than non-IDU-IE.

Conclusions: IE remains a highly morbid condition in Egyptian population. Our data suggest that although patients with IDU-IE are much younger and have fewer comorbid conditions, they need a greater number of antimicrobials, have longer hospital stay, still receive less surgical management than expected and suffer more pulmonary complications and higher mortality rates than a more at-risk non-IDU-IE cohort.