Endocarditis incidence rates in a tertiary center of Athens. how are people who inject drugs represented?

Background:
Approximately 90% of patients with right-sided infective endocarditis (IE) are people who inject drugs (PWID). Patients with a cardiac implantable electronic device (CIED) represent 9% of right-sided IE. However, right-sided IE represents only 10% of all cases, but the corresponding percentage for PWID with left-sided IE is still considerable, with 2 out of 10 patients being drug users.

Methods: Utilizing the relevant database of the Hippocration General Hospital of Athens, we attempted to determine whether the aforementioned percentages, regarding PWID and IE incidence, are reflected in our hospital. For that purpose, we recorded 100 consecutive cases of endocarditis, since 2022, focusing on factors such as injection drug use, preexisting artificial valve(s), presence of pacemaker or defibrillator, sex, age, length of stay and survival.

Results: Of the 100 cases, only 3 corresponded to PWID with IE, all male, with a mean age of 48 years. 28 patients were female, with a mean age of 70.5 years. The 69 non-PWID male patients had a mean age of 74 years. 25% of the patients exhibited vegetations on the aortic valve, 14% on the mitral valve and only 4% on the tricuspid or pulmonary valve. 37% had a CIED infection, while in the rest, the exact location of infection was not specified.

Conclusion: The difference in epidemiology could be attributed partly, to the fact that several patients with CIED infection are referred to our hospital for device extraction and further surgical treatment. However, considering that a significant number of PWID patients seek early discharge, there is the possibility that endocarditis is underdiagnosed due to insufficient workup. Expanding social support of PWID by offering easier access to care, housing and medical follow-up, is crucial, because untreated IE is unexceptionally fatal. Options to be explored include oral antimicrobials, long‐acting lipoglycopeptides and outpatient parenteral treatment administration.

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