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

Autor: Frances L Lucas, Kristina E. E. Rokas, Spencer Powers, Mylan Cohen, Marcella H Sorg, Christina Dematteo, Kinna Thakarar, Deirdre Mooney, August Valenti, Elizabeth Andrews
Rok vydání: 2019
Předmět:
Bacterial Diseases
Male
Emergency Medical Services
Critical Care and Emergency Medicine
Cardiovascular Procedures
030204 cardiovascular system & hematology
0302 clinical medicine
Medicine and Health Sciences
Odds Ratio
Public and Occupational Health
Hospital Mortality
030212 general & internal medicine
Substance Abuse
Intravenous
Analgesics
education.field_of_study
Multidisciplinary
Endocarditis
Mortality rate
Drugs
Middle Aged
Substance abuse
Infectious Diseases
Infective endocarditis
Medicine
Female
Behavioral and Social Aspects of Health
Research Article
Adult
medicine.medical_specialty
Cardiac Surgery
Death Rates
Science
Population
Cardiology
Surgical and Invasive Medical Procedures
03 medical and health sciences
Population Metrics
Harm Reduction
Internal medicine
medicine
Pain Management
Humans
education
Staphylococcal Infection
Aged
Retrospective Studies
Pharmacology
Harm reduction
Population Biology
business.industry
Biology and Life Sciences
Odds ratio
Emergency department
medicine.disease
Opioids
Health Care
Health Statistics
Morbidity
business
Zdroj: PLoS ONE, Vol 14, Iss 11, p e0225460 (2019)
PLoS ONE
ISSN: 1932-6203
Popis: 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.
Databáze: OpenAIRE
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