title: Endocarditis as a Marker for New Epidemics of Injection Drug Use.
abstract: BACKGROUND
  We examined discharges for infective endocarditis (IE) at an academic teaching hospital for over 10 years to evaluate if an increase in hospitalizations for IE and increase in hepatitis C virus (HCV) in patients with IE could predict a new epidemic of injection drug use (IDU).
  
  
  METHODS
  Retrospective medical record review of discharged patients with the diagnosis of IE as defined by the modified Duke criteria. Student's t test, chi-squared test and Fisher's exact test were used to calculate P values.
  
  
  RESULTS
  There were 542 discharges among 392 unique patients with IE and 104 patients were readmitted 2-7 times. Of the total discharges, 367 (67.7%) were not screened for HCV, and of those tested, 86 (49.1%) were HCV+; 404 (74.5%) were not screened for HIV and of those tested, 28 (20.3%) were HIV+. Patients who self-identify as a person who injects drugs were more likely to be tested for HCV, 75 (69.4%) versus 12 (31.5%, P < 0.0001), and for HIV, 72 (66.6%) versus 13 (34.2%, P < 0.0001) compared with those who self-report no IDU. Those with a positive result for opiate or heroin toxicology test were more likely to be screened for HCV, 70 (66%) versus 22 (44.8%, P < 0.0001), and for HIV, 66 (62.2%) versus 25 (51%, P < 0.0001) than those with negative result for toxicology test. Over this period, there was a 2-fold increase in IE cases, a 3-fold increase in HCV antibody prevalence and a 6-fold increase in opiate toxicology screens showing positive result, but no increase in HIV.
  
  
  CONCLUSIONS
  Although IDU is a known risk factor for IE, the observation of a sharp increase in IE cases may signal a new epidemic of IDU and HCV.
authors.affiliation: Department of Pediatrics, University of Utah College of Medicine, Salt Lake City, Utah. Electronic address: Susana.keeshin@hsc.utah.edu.
authors.forename: Susana Williams
authors.initials: SW
authors.lastname: Keeshin
authors.affiliation: Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia; Section of Infectious Diseases, Department of Medicine, West Virginia University School of Medicine, Morgantown, West Virginia.
authors.forename: Judith
authors.initials: J
authors.lastname: Feinberg
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D004696:Endocarditis / Q000453:epidemiology* / Q000209:etiology; D058872:Epidemics; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000209:etiology; D006526:Hepatitis C / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007267:Injections / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009820:Ohio / Q000453:epidemiology; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000453:epidemiology*
chemical_list: D000701:Analgesics, Opioid
keywords: Endocarditis; Hepatitis C virus; Human immunodeficiency virus; Injection drug use