Surgical treatment of infective endocarditis in intravenous drug abusers.
Adult
Cardiac Surgical Procedures
/ methods
Endocarditis, Bacterial
/ complications
Enterococcus
Female
Follow-Up Studies
Gram-Positive Bacterial Infections
/ complications
Humans
Male
Middle Aged
Postoperative Complications
/ epidemiology
Prospective Studies
Recurrence
Reoperation
/ statistics & numerical data
Risk Factors
Staphylococcal Infections
/ complications
Substance Abuse, Intravenous
/ complications
Treatment Outcome
High risk valve procedures
Infective endocarditis
Intravenous drug abuse
Journal
Journal of cardiothoracic surgery
ISSN: 1749-8090
Titre abrégé: J Cardiothorac Surg
Pays: England
ID NLM: 101265113
Informations de publication
Date de publication:
20 Apr 2021
20 Apr 2021
Historique:
received:
23
02
2021
accepted:
06
04
2021
entrez:
21
4
2021
pubmed:
22
4
2021
medline:
22
6
2021
Statut:
epublish
Résumé
Despite current progress in antibiotic therapy and medical management, infective endocarditis remains a serious condition presenting with high mortality rates. It also is a life-threatening complication in patients with a history of chronic intravenous drug abuse. In this study, we analyzed our institutional experience on the surgical therapy of infective endocarditis in patients with active intravenous drug abuse. The aim of the study is to identify the predictive factors of mortality and morbidity in this subgroup of patients. Between 2007 and 2020, a total of 24 patients (7 female, mean age 38.5 ± 8.7) presenting with active intravenous drug abuse underwent a surgical treatment for the infective endocarditis at out center. The primary endpoint was survival at 30th day after the surgery. The secondary composite endpoint included freedom from death, recurrent endocarditis, re-do surgery, and postoperative stroke during the follow-up period. Mean follow-up was 4.2 ± 4.3 years. Staphylococcus species was the most common pathogen detected in the preoperative blood cultures. Infection caused by Enterococcus species as well as liver function impairment were identified as mortality predictor factors. Logistic EuroSCORE and EusoSCORE-II were also predictive factors for mortality in univariate analysis. Survival at 1 and 3 years was 78 and 72% respectively. Thirty-day survival was 88%. 30-day freedom from combined endpoint was 83% and after 1 and 3 years, 69 and 58% of the patients respectively were free from combined endpoint. Five patients (20.8%) were readmitted with recurrent infective endocarditis. In patients presenting with active intravenous drug abuse, treatment of infective endocarditis should be performed as aggressively as possible and should be followed by antibiotic therapy to avoid high mortality rates and recurrent endocarditis. Early intervention is advisable in patients with an infective endocarditis and enterococcus species in the preoperative blood cultures, liver function deterioration as well as cardiac function impairment. Attention should be also payed to addiction treatment, due to the elevated relapse rate in patients who actively inject drugs. However, larger prospective studies are necessary to support our results. As septic shock is the most frequent cause of death, new treatment options, e.g. blood purification should be evaluated.
Sections du résumé
BACKGROUND
BACKGROUND
Despite current progress in antibiotic therapy and medical management, infective endocarditis remains a serious condition presenting with high mortality rates. It also is a life-threatening complication in patients with a history of chronic intravenous drug abuse. In this study, we analyzed our institutional experience on the surgical therapy of infective endocarditis in patients with active intravenous drug abuse. The aim of the study is to identify the predictive factors of mortality and morbidity in this subgroup of patients.
METHODS
METHODS
Between 2007 and 2020, a total of 24 patients (7 female, mean age 38.5 ± 8.7) presenting with active intravenous drug abuse underwent a surgical treatment for the infective endocarditis at out center. The primary endpoint was survival at 30th day after the surgery. The secondary composite endpoint included freedom from death, recurrent endocarditis, re-do surgery, and postoperative stroke during the follow-up period. Mean follow-up was 4.2 ± 4.3 years.
RESULTS
RESULTS
Staphylococcus species was the most common pathogen detected in the preoperative blood cultures. Infection caused by Enterococcus species as well as liver function impairment were identified as mortality predictor factors. Logistic EuroSCORE and EusoSCORE-II were also predictive factors for mortality in univariate analysis. Survival at 1 and 3 years was 78 and 72% respectively. Thirty-day survival was 88%. 30-day freedom from combined endpoint was 83% and after 1 and 3 years, 69 and 58% of the patients respectively were free from combined endpoint. Five patients (20.8%) were readmitted with recurrent infective endocarditis.
CONCLUSION
CONCLUSIONS
In patients presenting with active intravenous drug abuse, treatment of infective endocarditis should be performed as aggressively as possible and should be followed by antibiotic therapy to avoid high mortality rates and recurrent endocarditis. Early intervention is advisable in patients with an infective endocarditis and enterococcus species in the preoperative blood cultures, liver function deterioration as well as cardiac function impairment. Attention should be also payed to addiction treatment, due to the elevated relapse rate in patients who actively inject drugs. However, larger prospective studies are necessary to support our results. As septic shock is the most frequent cause of death, new treatment options, e.g. blood purification should be evaluated.
Identifiants
pubmed: 33879196
doi: 10.1186/s13019-021-01491-1
pii: 10.1186/s13019-021-01491-1
pmc: PMC8056573
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
97Références
Lancet. 2004 Jan 10;363(9403):139-49
pubmed: 14726169
JAMA. 2016 Feb 23;315(8):801-10
pubmed: 26903338
Int J Cardiol. 2015;187:472-4
pubmed: 25846656
Ann Thorac Surg. 2018 Jul;106(1):99-106
pubmed: 29452115
Clin Infect Dis. 2000 Apr;30(4):633-8
pubmed: 10770721
Arch Intern Med. 2002 Jan 14;162(1):90-4
pubmed: 11784225
Rev Infect Dis. 1988 Nov-Dec;10(6):1163-70
pubmed: 3060944
Enferm Infecc Microbiol Clin. 2020 Jun 15;:
pubmed: 32553427
J Cardiothorac Surg. 2020 Nov 16;15(1):330
pubmed: 33198774
Med Sci Monit. 2017 Jul 25;23:3617-3626
pubmed: 28740070
Braz J Cardiovasc Surg. 2020 Aug 01;35(4):411-419
pubmed: 32864918
Ann Thorac Surg. 2020 Sep;110(3):890-896
pubmed: 32059855
Ann Thorac Surg. 2015 Feb;99(2):539-46
pubmed: 25527426
Am J Med. 2016 May;129(5):481-5
pubmed: 26597670
Eur J Clin Microbiol Infect Dis. 1994 Jul;13(7):533-4
pubmed: 7805679
Int J Artif Organs. 2017 May 29;40(5):240-249
pubmed: 28525670
J Subst Abuse Treat. 2016 Aug;67:9-14
pubmed: 27296656
J Am Coll Cardiol. 2019 Feb 12;73(5):559-570
pubmed: 30732709
Ann Thorac Surg. 2015 Sep;100(3):875-82
pubmed: 26095108
Heart. 2006 Jan;92(1):124-30
pubmed: 16365367
Rev Esp Cardiol (Engl Ed). 2018 Feb;71(2):110
pubmed: 29425605
J Thorac Cardiovasc Surg. 2016 Sep;152(3):832-841.e1
pubmed: 27068439
BMC Infect Dis. 2018 Oct 24;18(1):532
pubmed: 30355291
Circulation. 2015 Jan 13;131(2):131-40
pubmed: 25480814
Braz J Cardiovasc Surg. 2020 Jun 01;35(3):265-273
pubmed: 32549097
CMAJ. 2011 Jul 12;183(10):1167-9
pubmed: 21624906
Arch Intern Med. 1998 Oct 12;158(18):2043-50
pubmed: 9778205
Circulation. 2015 Oct 13;132(15):1435-86
pubmed: 26373316
Ann Intern Med. 1992 Oct 1;117(7):560-6
pubmed: 1524330
Arch Intern Med. 1995 Aug 7-21;155(15):1641-8
pubmed: 7618988
Lancet Glob Health. 2017 Dec;5(12):e1192-e1207
pubmed: 29074409
JAMA. 2005 Jun 22;293(24):3012-21
pubmed: 15972563
Ann Thorac Surg. 2007 Dec;84(6):1943-8
pubmed: 18036912