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Long-term outcomes of intravenous drug use associated infective endocarditis: a contemporary 20-year study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Intravenous drug use (IVDU) associated infective endocarditis (IE) is a clinically challenging case. Not only can the natural history of IE in the IVDU population be significantly different, making detection a diagnostic dilemma, additional social factors associated with this population can drastically change management, including suitability for surgery or long-term intravenous access for antibiotics Furthermore, the rates of IVDU are increasing globally, leading to increasing incidence of IVDU associated IE.
Purpose
With a lack of clear mangement guidelines for IVDU associated IE, our study assesses the differences in presentation, management and long-term prognosis of IE between the IVDU population and the non-IVDU population to help guide future care.
Methods
This is an observational cohort study on a prospectively collected database of 350 patients treated for IE at our centre between 1999 and 2015. Patients were followed-up until death or January 2021. The primary outcome was all-cause mortality. Continuous variables were compared using unpaired t-test. Categorical variables were compared using Chi-square test when sample size was >5 or Fisher's exact test when sample size was ≤5. Long-term survival data was analysed using Kaplan-Meier survival curves.
Results
The IVDU population was younger, more likely to have concurrent infections and other substance use, while the non-IVDU population was older with a higher level of overall comorbidity. IVDU patients were more likely to become reinfected (p-value=0.034) but had better long-term survival compared to the non-IVDU population (p<0.001). Survival estimates at 15-years were 64.98% (95% CI: 50.94–75.92%) for the IVDU population compared to 26.67% (95% CI: 19.76–34.05%) for the non-IVDU population (p-value<0.0001).
Conclusion
Despite having higher levels of reinfection, IVDU patients have better long-term outcomes of IE compared to non-IVDU patients. Therefore, IVDU patients should not have blanket restrictions on the management they are offered unless the individual has clear contraindications to a particular therapy.
Funding Acknowledgement
Type of funding sources: None.
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Long-term Outcomes in Indigenous Australians Following Coronary Artery Bypass Surgery. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Characteristics, Outcomes and Prognostic Factors of Infective Endocarditis in the Intensive Care Unit. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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P56 Unnecessary Chest X-Rays? Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.03.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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630 Triglyceride-Glucose index as a novel biomarker for Coronary Artery Disease in metabolically healthy individuals. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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632 Waist/Hip Circumference and Ratio are Better Predictive Measures of Postoperative Outcomes in Patients Following Coronary Artery Bypass Graft Surgery Than Body Mass Index. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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026 Right-Sided Infective Endocarditis: The Importance of Vegetation Size. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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626 The Paradoxical Association of Preoperative PLR as a Predictor of Coronary Artery Disease. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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621 Preoperative Platelet to Lymphocyte Ratio as a Predictor for Readmission to ICU and ICU Length of Stay in Patients undergoing Coronary Artery Bypass Graft Surgery. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Preoperative Serum C-reactive Protein/Albumin Ratio Predicts Early Mortality and Adverse Outcomes following Cardiac Surgery. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Evaluation of Haematological and Biochemical Markers as Simple Predictors of In-hospital Mortality in Infective Endocarditis. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Six-Month Outcomes After High-Risk Coronary Artery Bypass Graft Surgery and Preoperative Intra-aortic Balloon Counterpulsation Use: An Inception Cohort Study. J Cardiothorac Vasc Anesth 2018; 32:2067-2073. [DOI: 10.1053/j.jvca.2018.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Indexed: 11/11/2022]
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Balloon Aortic Valvuloplasty Is a Safe and Effective Temporising Therapy Prior to Aortic Valve Intervention for Severe Symptomatic Aortic Stenosis. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Inpatient Cardiac Surgery–The Influence of Dual Antiplatelet Therapy on Wait Times and Outcomes. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Transcatheter aortic valve implantation - the St Vincent's Hospital (Melbourne) experience. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Concomitant Epicardial Left Ventricular Lead Implantation in Cardiac Surgical Patients with Impaired Cardiac Function. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Circulating Soluble Receptor for Advanced-Glycation End-Products is Elevated with Heparin Administration and Not by Cardiovascular Disease. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Measurement of Pre-operative Troponin to Predict Outcomes after Elective Coronary Artery Bypass Graft Surgery (CABG). Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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A Mid-Term Follow-Up of Surgical Ventricular Restoration Patients From the STICH Era. Heart Lung Circ 2011. [DOI: 10.1016/j.hlc.2011.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Sex Differences in Outcomes Following Isolated CABG Surgery in Australian Patients: Analysis of the Australasian Society of Cardiac and Thoracic Surgeons Cardiac Surgery Database. Heart Lung Circ 2011. [DOI: 10.1016/j.hlc.2010.11.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Is Obesity a Risk Factor for Adverse Outcome Following Coronary Artery Bypass Graft Surgery (CABG)? Heart Lung Circ 2011. [DOI: 10.1016/j.hlc.2011.05.553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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BMI is a Significant Predictor of Cost and Resource Utilization in Diabetic Patients Undergoing CABGS. Heart Lung Circ 2011. [DOI: 10.1016/j.hlc.2011.05.549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Chest Tube Bleeding and Mortality Following Cardiac Surgery. Heart Lung Circ 2010. [DOI: 10.1016/j.hlc.2010.06.567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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TS10�RARE CASE OF RETAINED FOREIGN BODY FOLLOWING PLEURAL DRAINAGE WITH A PIGTAIL CATHETER. ANZ J Surg 2009. [DOI: 10.1111/j.1445-2197.2009.04934_10.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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