title: Surgical outcomes of infective endocarditis among intravenous drug users.
abstract: With increasing prevalence of injected drug use in the United States, a growing number of intravenous drug users (IVDUs) are at risk for infective endocarditis (IE) that may require surgical intervention; however, few data exist about clinical outcomes of these individuals.
  
  
  
  We evaluated consecutive adult patients undergoing surgery for active IE between 2002 and 2014 pooled from 2 prospective institutional databases. Death and valve-related events, including reinfection or heart valve reoperation, thromboembolism, and anticoagulation-related hemorrhage were evaluated.
  
  
  
  Of the 436 patients identified, 78 (17.9%) were current IVDUs. The proportion of IVDUs increased from 14.8% in 2002 to 2004 to 26.1% in 2012 to 2014. IVDUs were younger (aged 35.9 ± 9.9 years vs 59.3 ± 14.1 years) and had fewer cardiovascular risk factors than non-IVDUs. During follow-up (median, 29.4 months; quartile 1-3, 4.7-72.6 months), adverse events among all patients included death in 92, reinfection in 42, valve-reoperation in 35, thromboembolism in 17, and hemorrhage in 16. Operative mortality was lower among IVDUs (odds ratio, 0.25; 95% confidence interval [CI], 0.06-0.71), but overall mortality was not significantly different (hazard ratio [HR], 0.78; 95% CI, 0.44-1.37). When baseline profiles were adjusted by propensity score, IVDUs had higher risk of valve-related complications (HR, 3.82; 95% CI, 1.95-7.49; P < .001) principally attributable to higher rates of reinfection (HR, 6.20; 95% CI, 2.56-15.00; P < .001).
  
  
  
  The proportion of IVDUs among surgically treated IE patients is increasing. Although IVDUs have lower operative risk, long-term outcomes are compromised by reinfection.
authors.affiliation: Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass; Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
authors.forename: Joon Bum
authors.initials: JB
authors.lastname: Kim
authors.affiliation: Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Julius I
authors.initials: JI
authors.lastname: Ejiofor
authors.affiliation: Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Maroun
authors.initials: M
authors.lastname: Yammine
authors.affiliation: Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Ando
authors.affiliation: Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Janice M
authors.initials: JM
authors.lastname: Camuso
authors.affiliation: Division of Infectious Disease, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Ilan
authors.initials: I
authors.lastname: Youngster
authors.affiliation: Division of Infectious Disease, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Sandra B
authors.initials: SB
authors.lastname: Nelson
authors.affiliation: Division of Infectious Disease, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Arthur Y
authors.initials: AY
authors.lastname: Kim
authors.affiliation: Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Serguei I
authors.initials: SI
authors.lastname: Melnitchouk
authors.affiliation: Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
authors.forename: James D
authors.initials: JD
authors.lastname: Rawn
authors.affiliation: Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: MacGillivray
authors.affiliation: Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Cohn
authors.affiliation: Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
authors.forename: John G
authors.initials: JG
authors.lastname: Byrne
authors.affiliation: Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass. Electronic address: tsundt@partners.org.
authors.forename: Thoralf M
authors.initials: TM
authors.lastname: Sundt
mesh_terms: D000328:Adult; D004696:Endocarditis / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D057216:Propensity Score; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D015819:Substance Abuse, Intravenous / Q000150:complications*; D016896:Treatment Outcome
keywords: infective endocarditis; intravenous drug use; operative risk; valvular heart disease