Opioid epidemic tied to infective endocarditis spike in NC

  • Schranz AJ & al.
  • Ann Intern Med
  • 10 Dec 2018

  • curated by Liz Scherer
  • Clinical Essentials
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Takeaway

  • From 2007 to 2017, rates of drug-use-associated infective endocarditis (DUA-IE) and hospitalizations for surgery increased more than 12-fold in North Carolina (NC).

Why this matters

  • Address underlying drug-use disorder (especially in younger patients) to mitigate risk for reinfection from injection drug use.

Key results

  • 11% (2602/22,825) IE hospitalizations for DUA-IE.
  • Annual DUA-IE hospitalizations rose from 64 (0.92/100,000) in 2007-2008 to 867 (10.95/100,000) in 2016-2017.
  • Corresponding annual hospitalizations with valve surgery rose from 1.62/100,000 (2007-2008) to 3.26/100,000 (2016-2017); DUA-IE hospitalizations with surgery rose from
  • In 2017, 42% of IE valve surgeries were performed in patients with DUA-IE.
  • DUA-IE hospitalizations occurred more frequently in younger (median age, 35 [interquartile range (IQR), 28-45] years) vs older (median, 67 [IQR, 54-79] years) persons.
  • DUA-IE hospitalizations with valve surgery occurred more often in younger (median, 33 [IQR, 27-42] years) vs older (median, 56 [IQR, 44-66] years) people.
  • Opioids were the most commonly reported drug (62% of cases, n=176); 18.24% cases (n=52/176) coded for HCV.

Study design

  • Retrospective discharge data analysis of NC DUA-IE hospitalization rates and related valve surgery, patient characteristic from 2007 to 2017.
  • Funding: NIH.

Limitations

  • Retrospective.
  • Coding inaccuracies.
  • Reliance on HCV infection as drug-use indicator.
  • Underestimated IE prevalence.
  • Nongeneralizable.

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