Large spike in drug use-associated infective endocarditis linked with opioid epidemic

1. Researchers have identified a significant increase in hospitalizations due to infective endocarditis related to drug use.

2. Heart valve surgeries among patients with drug use-associated infective endocarditis have also increased with the opioid epidemic.

Evidence Rating Level: 2 (Good)

Study Rundown: The authors of this study utilized a statewide hospital discharge database to examine hospitalization trends associated with drug use-related infective endocarditis. This condition arises due to use of injection drugs that result in severe infection of heart valves. Generally, the authors observed that the increase in endocarditis prevalence is largely driven by drug use-associated infective endocarditis and associated temporally with the opioid epidemic. A similar increase was not observed in patients with endocarditis without drug-use. The main limitation of this study was that it relied on the accuracy of hospital billings and administrative data. The authors acknowledged that administrative data may be lacking in clinical details that are important for data interpretation.

Click to read the study in Annals of Internal Medicine

Relevant Reading: Hospitalizations related to opioid abuse/dependence and associated serious infections from 2002 to 2012

In-Depth [retrospective cohort]: The authors assessed epidemiologic trends for drug use-associated infective endocarditis. Study endpoints included the proportion of hospitalizations with surgery, patient characteristics and length of stay among others. The researchers conducted a 10-year assessment of a statewide hospital discharge database in North Carolina from 2007 to 2017. In total, approximately 11% of the hospitalizations for infective endocarditis were related to drug-use, but the percentage has increased yearly. Valve surgery was performed for a total of 7% of all of the infective endocarditis admissions. The rate of drug use-associated infective endocarditis admissions and admissions with valve surgery increased nearly ten-fold during the study time period. The authors observed that patients hospitalized for drug use-associated endocarditis tended to be younger, female and Caucasian.

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