title: Low mortality but increasing incidence of Staphylococcus aureus endocarditis in people who inject drugs: Experience from a Swedish referral hospital.
abstract: Staphylococcus aureus is a leading cause of infective endocarditis in people who inject drugs (PWID). The management of S aureus endocarditis (SAE) in PWID can be problematic. The objective of this retrospective observational study was to assess the epidemiology, clinical characteristics, and mortality of S aureus endocarditis (SAE) in PWID in Stockholm, Sweden.The Department of Infectious Diseases at the Karolinska University Hospital serves as a regional referral center for drug users with severe infections. Patients with active intravenous drug use treated for SAE at the department between January 2004 and December 2013 were retrospectively identified. Clinical and microbiological data were obtained from medical records and the diagnosis verified according to the modified Duke criteria.In total, 120 SAE episodes related to intravenous drug use were identified. Its incidence in Stockholm was 0.76/100,000 adult person-years for the entire period, increasing from 0.52/100,000 person-years in 2004 to 2008 to 0.99 in 2009 to 2013 (P = 0.02). The SAE incidence among PWID specifically was 249 (range 153-649) /100,000 person-years. Forty-two (35%) episodes were left-sided, and multiple valves were involved in 26 (22%). Cardiac valve surgery was performed in 10 (8%) episodes, all left-sided. The in-hospital and 1-year mortality rates were 2.5% (3 deaths) and 8.0% (9 deaths), respectively.We noted a high and increasing incidence over time of SAE related to intravenous drug use in Stockholm. The increased incidence partly reflects a rising number of PWID during the study period. The low mortality noted, despite a substantial proportion with left-sided endocarditis, probably in part reflects the quality of care obtained at a large and specialized referral center for drug users with severe infections.
authors.affiliation: Department of Infectious Diseases, Karolinska University Hospital Huddinge Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Hilmir
authors.initials: H
authors.lastname: Asgeirsson
authors.forename: Anders
authors.initials: A
authors.lastname: Thalme
authors.forename: Ola
authors.initials: O
authors.lastname: Weiland
mesh_terms: D000328:Adult; D017677:Age Distribution; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D006348:Cardiac Surgical Procedures / Q000379:methods; D002423:Cause of Death; D015331:Cohort Studies; D003131:Combined Modality Therapy; D004697:Endocarditis, Bacterial / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007262:Infusions, Intravenous; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000209:etiology; D018709:Statistics, Nonparametric; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000453:epidemiology*; D015996:Survival Rate; D013548:Sweden / Q000453:epidemiology; D062606:Tertiary Care Centers; D014505:Urban Population
chemical_list: D000900:Anti-Bacterial Agents