title: Surgical treatment of infective endocarditis in active intravenous drug users: a justified procedure?
abstract: BACKGROUND
  Infective endocarditis is a life threatening complication of intravenous drug abuse, which continues to be a major burden with inadequately characterised long-term outcomes. We reviewed our institutional experience of surgical treatment of infective endocarditis in active intravenous drug abusers with the aim of identifying the determinants long-term outcome of this distinct subgroup of infective endocarditis patients.
  
  
  METHODS
  A total of 451 patients underwent surgery for infective endocarditis between January 1993 and July 2013 at the University Hospital of Heidelberg. Of these patients, 20 (7 female, mean age 35 ± 7.7 years) underwent surgery for infective endocarditis with a history of active intravenous drug abuse. Mean follow-up was 2504 ± 1842 days.
  
  
  RESULTS
  Staphylococcus aureus was the most common pathogen detected in preoperative blood cultures. Two patients (10%) died before postoperative day 30. Survival at 1, 5 and 10 years was 90%, 85% and 85%, respectively. Freedom from reoperation was 100%. Higher NYHA functional class, higher EuroSCORE II, HIV infection, longer operating time, postoperative fever and higher requirement for red blood cell transfusion were associated with 90-day mortality.
  
  
  CONCLUSIONS
  In active intravenous drug abusers, surgical treatment for infective endocarditis should be performed as extensively as possible and be followed by an aggressive postoperative antibiotic therapy to avoid high mortality. Early surgical intervention is advisable in patients with precipitous cardiac deterioration and under conditions of staphylococcal endocarditis. However, larger studies are necessary to confirm our preliminary results.
authors.affiliation: Department of Cardiac Surgery, Heart and Marfan Center, University Hospital of Heidelberg, Im Neuenheimer Feld 110, Heidelberg 69120, Germany. weymann.alexander@googlemail.com.
authors.forename: Alexander
authors.initials: A
authors.lastname: Weymann
authors.forename: Tobias
authors.initials: T
authors.lastname: Borst
authors.forename: Aron-Frederik
authors.initials: AF
authors.lastname: Popov
authors.forename: Anton
authors.initials: A
authors.lastname: Sabashnikov
authors.forename: Christopher
authors.initials: C
authors.lastname: Bowles
authors.forename: Bastian
authors.initials: B
authors.lastname: Schmack
authors.forename: Gabor
authors.initials: G
authors.lastname: Veres
authors.forename: Nicole
authors.initials: N
authors.lastname: Chaimow
authors.forename: Andre Rüdiger
authors.initials: AR
authors.lastname: Simon
authors.forename: Matthias
authors.initials: M
authors.lastname: Karck
authors.forename: Gábor
authors.initials: G
authors.lastname: Szabo
mesh_terms: D000328:Adult; D055030:Drug Users; D004696:Endocarditis / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D015819:Substance Abuse, Intravenous / Q000503:physiopathology*