Skip to main content

Advertisement

Log in

Infective endocarditis in intravenous drug abusers: an update

  • Review
  • Published:
European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

Abstract

Infective endocarditis despite advances in diagnosis remains a common cause of hospitalization, with high morbidity and mortality rates. Through literature review it is possible to conclude that polymicrobial endocarditis occurs mainly in intravenous drug abusers with predominance in the right side of the heart, often with tricuspid valve involvement. This fact can be associated with the type of drug used by the patients; therefore, knowledge of the patient's history is critical for adjustment of the therapy. It is also important to emphasize that the most common combinations of organisms in polymicrobial infective endocarditis are: Staphylococcus aureus, Streptococcus pneumonia and Pseudomonas aeruginosa, as well as mixed cultures of Candida spp. and bacteria. A better understanding of the epidemiology and associated risk factors are required in order to develop an efficient therapy, although PE studies are difficult to perform due to the rarity of cases and lack of prospective cohorts.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Horstkotte D, Follath F, Gutschik E et al (2004) Guidelines on prevention, diagnosis and treatment of infective endocarditis. Eur Heart J 25:267–276

    Article  PubMed  Google Scholar 

  2. Mylonakis E, Calderwood SB (2001) Infective endocarditis in adults. N Engl J Med 345:1318–1330

    Article  PubMed  CAS  Google Scholar 

  3. Elliott TSJ, Foweraker J, Gould FK et al (2004) Guidelines for the antibiotic treatment of endocarditis in adults: report of the Working Party of the British Society for Antimicrobial Chemotherapy. J Antimicrob Chemother 54:971–981

    Article  PubMed  CAS  Google Scholar 

  4. Sousa C, Henriques M, Oliveira R (2011) Mini-review: antimicrobial central venous catheters–recent advances and strategies. Biofouling 27(6):609–620

    Article  PubMed  CAS  Google Scholar 

  5. Netzer RO, Zollinger E, Seiler C et al (2000) Infective endocarditis: Clinical spectrum, presentation and outcome. An analysis of 212 cases: 1980–1995. Heart 84:25–30

    Article  PubMed  CAS  Google Scholar 

  6. Wang A, Athan E, Pappas PA et al (2007) Contemporary clinical profile and outcome of prosthetic valve endocarditis. JAMA 297:1354–1361

    Article  PubMed  CAS  Google Scholar 

  7. Rostagno C, Rosso G, Puggelli F et al (2010) Active infective endocarditis: Clinical characteristics and factors related to hospital mortality. Cardiol J 17:566–573

    PubMed  Google Scholar 

  8. Sedgwick JF, Burstow DJ (2012) Update on echocardiography in the management of infective endocarditis. Curr Infect Dis Rep. Apr 29. [Epub ahead of print]

  9. Bayer AS, Bolger AF, Taubert KA et al (1998) Diagnosis and management of infective endocarditis and its complications. Circulation 22–29(98):2936–2948

    Article  Google Scholar 

  10. Nagji G, Rémadi JP, Coviaux F et al (2005) Comparison of clinical and morphological characteristics of Staphylococcus endocarditis with endocarditis caused by other pathogens. Heart 91:932–937

    Article  Google Scholar 

  11. Leitman M, Dreznik Y, Tyomkin V et al (2012) Vegetation size in patients with infective endocarditis. Eur Heart J Cardiovasc Imaging 13(4):330–338

    Article  PubMed  Google Scholar 

  12. Bouza E, Menasalvas A, Munoz P et al (2001) Infective endocarditis: a prospective study at the end of the twentieth century-new predisposing conditions, new etiologic agents, and still a high mortality. Medicine 80:298–307

    Article  PubMed  CAS  Google Scholar 

  13. Prendergast BD (2006) The changing face of infective endocarditis. Heart 92:879–885

    Article  PubMed  CAS  Google Scholar 

  14. Karchmer AW, Gibbons GW (1994) Infections of prosthetic heart valves andvascular grafts. In: Bisno AL (ed) Infections Associated With Indwelling Medical Devices. American Society for Microbiology, Washington, DC

    Google Scholar 

  15. Moyer D, Edwards JE (1992) Fungal endocarditis. In: Kaye D (ed) Infective Endocarditis. Raven Press, New York

    Google Scholar 

  16. Moreillon P, Que Y (2004) Infective endocarditis. Lancet 363:139–149

    Article  PubMed  Google Scholar 

  17. Cooper HL, Brady JE, Ciccarone D et al (2007) Nationwide increase in the number of hospitalizations for illicit injection drug use-related infective endocarditis. Clin Infect Dis 45:1200–1203

    Article  PubMed  Google Scholar 

  18. Gebo KA, Burkey MD, Lucas GM et al (2006) Incidence of, risk factors for clinical presentation, and 1-year outcomes of infective endocarditis in an urban HIV cohort. J Acquir Immune Defic Syndr 43:426–432

    Article  PubMed  Google Scholar 

  19. Wilson LE, Thomas DL, Astemborski J et al (2002) Prospective study of infective endocarditis among injection drug users. J Infect Dis 185:1761–1766

    Article  PubMed  Google Scholar 

  20. Fowler VG Jr, Miro JM, Hoen B et al (2005) Staphylococcus aureus endocarditis: a consequence of medical progress. JAMA 293:3012–3021

    Article  PubMed  CAS  Google Scholar 

  21. Ellis ME, Al-Abdely H, Sandridge A et al (2001) Fungal endocarditis: evidence in the world literature, 1965–1995. Clin Infect Dis 32:50–62

    Article  PubMed  CAS  Google Scholar 

  22. Shively BK (2003) Infective endocarditis. In: M. Crawdord (ed) Current Diagnosis & Treatment in Cardiology. McGraw Hill

  23. Miró JM, del Rio A, Mestres CA (1997) Infective endocarditis in intravenous drug abusers and HIV-1 infected patients. Infect Dis Clin North Am 16:273–295

    Article  Google Scholar 

  24. Araújo IR, Nunes Mdo C, Gelape CL et al (2012) Challenge in the management of infective endocarditis with multiple valvular involvement. Rev Soc Bras Med Trop 45(2):272–274

    Article  PubMed  Google Scholar 

  25. Moss R, Munt B (2003) Injection drug use and right sided endocarditis. Heart 89:577–581

    Article  PubMed  Google Scholar 

  26. Brown P, Levine D (2002) Infective endocarditis in the injection drug user. Infect Dis Clin N Am 16:645–665

    Article  Google Scholar 

  27. Mathew J, Addai T, Anand A et al (1995) Clinical features, site of involvement, bacteriologic findings, and outcome of infective endocarditis in intravenous drug users. Arch Intern Med 155:1641–1648

    Article  PubMed  CAS  Google Scholar 

  28. Carozza A, De Santo LS, Romano G et al (2006) Infective endocarditis in intravenous drug abusers: patterns of presentation and long-term outcomes of surgical treatment. J Heart Valve Dis 15:125–131

    PubMed  Google Scholar 

  29. San Roman JA, Vilacosta I, Sarria C et al (2001) Eustachian valve endocarditis: is it worth searching for? Am Heart J 142:1037–1040

    Article  PubMed  CAS  Google Scholar 

  30. Kim N, Lazar JM, Cunha BA et al (2000) Multivalvular endocarditis. Clin Microbiol Infect 6:207–212

    Article  PubMed  CAS  Google Scholar 

  31. Oh S, Havlen PR, Hussain N et al (2005) A case of polymicrobial endocarditis caused by anaerobic organisms in an injection drug user. J Gen Intern Med 20:C1–C2

    Article  PubMed  Google Scholar 

  32. Levine DP, Crane LR, Zervos MJ (1986) Bacteremia in narcotic addicts at the Detroit Medical Center. II. Infectious endocarditis: a prospective comparative study. Rev Infect Dis 8:374–396

    Article  PubMed  CAS  Google Scholar 

  33. Jain V, Yang MH, Kovacicova-Lezcano G et al (2008) Infective endocarditis in an urban medical center: association of individual drugs with valvular involvement. J Infect 57:132–138

    Article  PubMed  Google Scholar 

  34. Saydain G, Singh J, Dalal B et al (2010) Outcome of patients with injection drug use-associated endocarditis admitted to an intensive care unit. J Crit Care 25:248–253

    Article  PubMed  Google Scholar 

  35. Lee CY, Chang TM, Lin CJ et al (2012) Infective endocarditis caused by community-associated methicillin-resistant Staphylococcus aureus in a previously healthy preschool child. J Microbiol Immunol Infect. May 8. [Epub ahead of print]

  36. Cherubin CE, Sapira JD (1993) The medical complications of drug addiction and the medical assessment of the intravenous drug user: 25 years later. Ann Intern Med 119:1017–1028

    PubMed  CAS  Google Scholar 

  37. Crane LR, Levine DP, Zervos MJ et al (1986) Bacteremia in narcotic addicts at the Detroit Medical Center. I. Microbiology, epidemiology, risk factors, and empiric therapy. Rev Infect Dis 8:364–373

    Article  PubMed  CAS  Google Scholar 

  38. Botsford KB, Weinstein RA, Nathan CR et al (1985) Selective survival in pentazocine and tripelennamine of Pseudomonas aeruginosa serotype O11 from drug addicts. J Infect Dis 151:209–216

    Article  PubMed  CAS  Google Scholar 

  39. Bisbe J, Miro JM, Latorre X et al (1992) Disseminated candidiasis in addicts who use brown heroin: report of 83 cases and review. Clin Infect Dis 15:910–923

    Article  PubMed  CAS  Google Scholar 

  40. Brito LR, Guimarães T, Nucci M et al (2006) Clinical and microbiological aspects of candidemia due to Candida parapsilosis in Brazilian tertiary care hospitals. Med Mycol 44:261–266

    Article  PubMed  Google Scholar 

  41. Daas H, Abuhmaid F, Zervos M (2009) Successful treatment of Candida parapsilosis and Pseudomonas aeruginosa infection using medical and surgical management in an injecting drug user with mitral and aortic valve endocarditis: a case report. J Med Case Rep 3:6598

    Article  PubMed  Google Scholar 

  42. Baddour LM, Meyer J, Henry B (1991) Polymicrobial infective endocarditis in the 1980s. Rev Infect Dis 13:963–970

    Article  PubMed  CAS  Google Scholar 

  43. Wang'ondu RW, Murray TS (2011) Relapse of polymicrobial endocarditis in an intravenous drug user. Yale J Biol Med 84(3):321–324

    PubMed  Google Scholar 

  44. Houry D, Crisman T (1999) Bivalve polymicrobial infective endocarditis. South Med J 1098–1099

  45. Saravolatz LD, Burch KH, Quinn EL et al (1978) Polymicrobial infective endocarditis: an increasing clinical entity. Am Heart J 95:163–168

    Article  PubMed  CAS  Google Scholar 

  46. Adler AG, Blumberg EA, Schwartz DA et al (1991) Seven-pathogen tricuspid endocarditis in an intravenous drug abuser. Pitfalls in laboratory diagnosis. Chest 99:490–491

    Article  PubMed  CAS  Google Scholar 

  47. Raucher B, Dobkin J, Mandel L et al (1989) Occult polymicrobial endocarditis with Haemophilus parainfluenzae in intravenous drug abusers. Am J Med 86:169–172

    Article  PubMed  CAS  Google Scholar 

  48. Mager DL, Ximenez-Fyvie LA, Haffajee AD et al (2003) Distribution of selected bacterial species on intraoral surfaces. J Clin Periodontol 30:644–654

    Article  PubMed  Google Scholar 

  49. Tran C, Cometta A, Letovanec I et al (2007) Candida dubliniensis in recurrent polymicrobial tricuspid endocarditis. Echocardiogr 24:756–759

    Article  Google Scholar 

  50. Baddley JW, Benjamin DK Jr, Patel M, International Collaboration on Endocarditis-Prospective Cohort Study Group (ICE-PCS) et al (2008) Candida infective endocarditis. Eur J Clin Microbiol Infect Dis 27:519–529

    Article  PubMed  CAS  Google Scholar 

  51. Benjamin DK Jr, Miro JM, Hoen B et al (2004) Candida endocarditis: contemporary cases from the International Collaboration of Infectious Endocarditis Merged Database (ICE-mD). Scand J Infect Dis 36:453–455

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by Portuguese Foundation for Science and Technology (FCT) through the grants SFRH/BPD/47693/2008, SFRH/BPD/20987/2004 and SFRH/BPD/72632/2010 attributed to Cláudia Sousa, Cláudia Botelho and Diana Rodrigues, respectively.

Conflict of interest

There is no conflict of interest.

Author’s knowledge

All authors had access to the data and a role in writing the manuscript

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to R. Oliveira.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sousa, C., Botelho, C., Rodrigues, D. et al. Infective endocarditis in intravenous drug abusers: an update. Eur J Clin Microbiol Infect Dis 31, 2905–2910 (2012). https://doi.org/10.1007/s10096-012-1675-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10096-012-1675-x

Keywords

Navigation