title: Suboptimal Addiction Interventions for Patients Hospitalized with Injection Drug Use-Associated Infective Endocarditis.
abstract: Infective endocarditis is a serious infection, often resulting from injection drug use. Inpatient treatment regularly focuses on management of infection without attention to the underlying addiction. We aimed to determine the addiction interventions done in patients hospitalized with injection drug use-associated infective endocarditis.
  
  
  
  This is a retrospective review of patients hospitalized with injection drug use-associated infective endocarditis from January, 2004 through August, 2014 at a large academic tertiary care center in Boston, Massachusetts. For the initial and subsequent admissions, data were collected regarding addiction interventions, including consultation by social work, addiction clinical nurse and psychiatry, documentation of addiction in the discharge summary plan, plan for medication-assisted treatment and naloxone provision.
  
  
  
  There were 102 patients admitted with injection drug use-associated infective endocarditis, 50 patients (49.0%) were readmitted and 28 (27.5%) patients had ongoing injection drug use at readmission. At initial admission, 86.4% of patients had social work consultation, 23.7% had addiction consultation, and 24.0% had psychiatry consultation. Addiction was mentioned in 55.9% of discharge summary plans, 7.8% of patients had a plan for medication-assisted treatment, and naloxone was never prescribed. Of 102 patients, 26 (25.5%) are deceased. The median age at death was 40.9 years (interquartile range 28.7-48.7).
  
  
  
  We found that patients hospitalized with injection drug use-associated infective endocarditis had high rates of readmission, recurrent infective endocarditis and death. Despite this, addiction interventions were suboptimal. Improved addiction interventions are imperative in the treatment of injection drug use-associated infective endocarditis.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Mass; Harvard Medical School, Boston, Mass. Electronic address: elana.rosenthal@gmail.com.
authors.forename: Elana S
authors.initials: ES
authors.lastname: Rosenthal
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Mass; Harvard Medical School, Boston, Mass.
authors.forename: Adolf W
authors.initials: AW
authors.lastname: Karchmer
authors.affiliation: Harvard Medical School, Boston, Mass; Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Mass.
authors.forename: Jesse
authors.initials: J
authors.lastname: Theisen-Toupal
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Mass; Harvard Medical School, Boston, Mass.
authors.forename: Roger Araujo
authors.initials: RA
authors.lastname: Castillo
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Mass; Harvard Medical School, Boston, Mass; Harvard School of Public Health, Boston, Mass.
authors.forename: Chris F
authors.initials: CF
authors.lastname: Rowley
mesh_terms: D000328:Adult; D001900:Boston / Q000453:epidemiology; D003419:Crisis Intervention / Q000706:statistics & numerical data*; D004696:Endocarditis / Q000209:etiology*; D005260:Female; D006801:Humans; D007267:Injections / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Harm reduction; Infective endocarditis; Injection drug use; Medication-assisted treatment; Substance use disorder