title: Opiate Injection-associated Infective Endocarditis in the Southeastern United States.
abstract: BACKGROUND
  Opiate pain reliever (OPR) misuse by injection is increasing in the United States. Infective endocarditis (IE), a devastating complication of injection OPR use, has been understudied.
  
  
  METHODS
  We conducted a retrospective chart review of IE cases at an academic tertiary care hospital in North Carolina. Hospital admissions from 2009-2014 were screened for cases of definite IE. Subjects reporting injection drug use (IDU) were classified as IDU-IE, and compared to those without reported IDU, classified as No IDU-IE. Rates of IDU-IE and No IDU-IE, patient demographics, microbiologic data and outcomes were compared between the groups.
  
  
  RESULTS
  A total of 127 incident admissions for IE were identified, 48 (37.8%) were classified as IDU-IE and 79 (62.2%) as No IDU-IE. IDU-IE cases increased from 14% of hospitalizations for IE in 2009 to 56% in 2014; reporting of OPR injection increased in 2012 and continued through the study period. IDU-IE subjects were younger (32.6 ± 11.7 versus 54.4 ± 13.1, P < 0.0001), more likely to be single (n = 33 [68.8%] versus n = 23 [29.1%], P < 0.0001) and to reside in rural communities (n = 36 [75.0%] versus n = 25 [31.6%], P < 0.0001) than No IDU-IE subjects. Hospital length of stay (26 days versus 12 days, P < 0.0001) and intensive care unit length of stay (2 days versus 1 day, P = 0.04) were longer for IDU-IE patients and hospital mortality did not differ (10.4% IDU-IE versus 8.9% No IDU-IE, P = 0.77).
  
  
  CONCLUSIONS
  IDU-IE rates increased over time, and OPR injection use in rural communities appears to be a major contributor. Interventions to reduce IDU-IE and OPR misuse are needed to halt this growing epidemic in at-risk rural communities.
authors.affiliation: Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Lauren
authors.initials: L
authors.lastname: Hartman
authors.affiliation: Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Infectious Disease, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Erin
authors.initials: E
authors.lastname: Barnes
authors.affiliation: Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Infectious Disease, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Laura
authors.initials: L
authors.lastname: Bachmann
authors.affiliation: Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Infectious Disease, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Katherine
authors.initials: K
authors.lastname: Schafer
authors.affiliation: Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: James
authors.initials: J
authors.lastname: Lovato
authors.affiliation: Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Pulmonary, Critical Care, Allergy and Immunologic Diseases, Wake Forest School of Medicine, Winston-Salem, NC; Department of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina. Electronic address: dfiles@wakehealth.edu.
authors.forename: Daniel Clark
authors.initials: DC
authors.lastname: Files
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D055030:Drug Users; D004696:Endocarditis / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D007267:Injections / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015144:Southeastern United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid
keywords: Critical care; Infection; Injection drug use; Opana; Oxymorphone