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ArtigoDireito Autoral
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- INI - Artigos de Periódicos [3496]
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PROSPECTIVE COHORT STUDY OF INFECTIVE ENDOCARDITIS IN PEOPLE WHO INJECT DRUGS
Staphylococcus aureus
Cardiac surgery
Infective endocarditis
Opioid crisis
People who inject drugs
Autor(es)
Pericàs, Juan M.
Llopis, Jaume
Athan, Eugene
Hernández-Meneses, Marta
Hannan, Margaret M.
Murdoch, David R.
Kanafani, Zeina
Freiberger, Tomas
Strahilevitz, Jacob
Fernández-Hidalgo, Nuria
Lamas, Cristiane
Durante-Mangoni, Emanuele
Tattevin, Pierre
Nacinovich, Francisco
Chu, Vivian H.
Miró, José M.
International Collaboration on Endocarditis (ICE) Investigators
Llopis, Jaume
Athan, Eugene
Hernández-Meneses, Marta
Hannan, Margaret M.
Murdoch, David R.
Kanafani, Zeina
Freiberger, Tomas
Strahilevitz, Jacob
Fernández-Hidalgo, Nuria
Lamas, Cristiane
Durante-Mangoni, Emanuele
Tattevin, Pierre
Nacinovich, Francisco
Chu, Vivian H.
Miró, José M.
International Collaboration on Endocarditis (ICE) Investigators
Afiliação
University of Barcelona. Hospital Clinic-IDIBAPS. Infectious Diseases Department. Barcelona, Spain.
University of Barcelona. Hospital Clinic-IDIBAPS. Infectious Diseases Department. Barcelona, Spain / University of Barcelona. Microbiology and Statistics. Department of Genetics. Barcelona, Spain.
Barwon Health and Deakin University. Department of Infectious Disease. Geelong, Australia.
University of Barcelona. Hospital Clinic-IDIBAPS. Infectious Diseases Department. Barcelona, Spain.
Mater Misericordiae University Hospital. Department of Microbiology. Dublin, Ireland.
University of Otago. Department of Pathology and Biomedical Science. Christchurch, New Zealand.
American University of Beirut. Division of Infectious Diseases. Beirut, Lebanon.
Centre for Cardiovascular Surgery and Transplantation. Brno, Czech Republic / Masaryk University. Faculty of Medicine. Brno, Czech Republic.
Hadassah-Hebrew University Medical Center. Jerusalem, Israel.
Universitat Autònoma de Barcelona. Hospital Universitari Vall d'Hebron. Servei de Malalties Infeccioses. Barcelona, Spain.
Instituto Nacional de Cardiologia and Unigranrio. Rio de Janeiro, RJ, Brazil.
University of Campania. Monaldi Hospital. Internal Medicine. Naples, Italy.
Pontchaillou University Hospital. Infectious diseases and intensive care unit. Rennes, France.
Instituto Cardiovascular de Buenos Aires. Buenos Aires, Argentina.
Duke University School of Medicine. Durham, North Carolina, USA.
University of Barcelona. Hospital Clinic-IDIBAPS. Infectious Diseases Department. Barcelona, Spain.
University of Barcelona. Hospital Clinic-IDIBAPS. Infectious Diseases Department. Barcelona, Spain / University of Barcelona. Microbiology and Statistics. Department of Genetics. Barcelona, Spain.
Barwon Health and Deakin University. Department of Infectious Disease. Geelong, Australia.
University of Barcelona. Hospital Clinic-IDIBAPS. Infectious Diseases Department. Barcelona, Spain.
Mater Misericordiae University Hospital. Department of Microbiology. Dublin, Ireland.
University of Otago. Department of Pathology and Biomedical Science. Christchurch, New Zealand.
American University of Beirut. Division of Infectious Diseases. Beirut, Lebanon.
Centre for Cardiovascular Surgery and Transplantation. Brno, Czech Republic / Masaryk University. Faculty of Medicine. Brno, Czech Republic.
Hadassah-Hebrew University Medical Center. Jerusalem, Israel.
Universitat Autònoma de Barcelona. Hospital Universitari Vall d'Hebron. Servei de Malalties Infeccioses. Barcelona, Spain.
Instituto Nacional de Cardiologia and Unigranrio. Rio de Janeiro, RJ, Brazil.
University of Campania. Monaldi Hospital. Internal Medicine. Naples, Italy.
Pontchaillou University Hospital. Infectious diseases and intensive care unit. Rennes, France.
Instituto Cardiovascular de Buenos Aires. Buenos Aires, Argentina.
Duke University School of Medicine. Durham, North Carolina, USA.
University of Barcelona. Hospital Clinic-IDIBAPS. Infectious Diseases Department. Barcelona, Spain.
Resumo em Inglês
Background: Infective endocarditis (IE) in people who inject drugs (PWID) is an emergent public health problem.
Objectives: The purpose of this study was to investigate IE in PWID and compare it with IE in non-PWID patients.
Methods: Two prospective cohort studies (ICE-PCS and ICE-Plus databases, encompassing 8,112 IE episodes from 2000 to 2006 and 2008 to 2012, with 64 and 34 sites and 28 and 18 countries, respectively). Outcomes were compared between PWID and non-PWID patients with IE. Logistic regression analyses were performed to investigate risk factors for 6-month mortality and relapses amongst PWID.
Results: A total of 7,616 patients (591 PWID and 7,025 non-PWID) were included. PWID patients were significantly younger (median 37.0 years [interquartile range: 29.5 to 44.2 years] vs. 63.3 years [interquartile range: 49.3 to 74.0 years]; p < 0.001), male (72.5% vs. 67.4%; p = 0.007), and presented lower rates of comorbidities except for human immunodeficiency virus, liver disease, and higher rates of prior IE. Amongst IE cases in PWID, 313 (53%) episodes involved left-side valves and 204 (34.5%) were purely left-sided IE. PWID presented a larger proportion of native IE (90.2% vs. 64.4%; p < 0.001), whereas prosthetic-IE and cardiovascular implantable electronic device-IE were more frequent in non-PWID (9.3% vs. 27.0% and 0.5% vs. 8.6%; both p < 0.001). Staphylococcus aureus caused 65.9% and 26.8% of cases in PWID and non-PWID, respectively (p < 0.001). PWID presented higher rates of systemic emboli (51.1% vs. 22.5%; p < 0.001) and persistent bacteremia (14.7% vs. 9.3%; p < 0.001). Cardiac surgery was less frequently performed (39.5% vs. 47.8%; p < 0.001), and in-hospital and 6-month mortality were lower in PWID (10.8% vs. 18.2% and 14.4% vs. 22.2%; both p < 0.001), whereas relapses were more frequent in PWID (9.5% vs. 2.8%; p < 0.001). Prior IE, left-sided IE, polymicrobial etiology, intracardiac complications, and stroke were risk factors for 6-month mortality, whereas cardiac surgery was associated with lower mortality in the PWID population.
Conclusions: A notable proportion of cases in PWID involve left-sided valves, prosthetic valves, or are caused by microorganisms other than S. aureus.
Palavras-chave em inglês
HIVStaphylococcus aureus
Cardiac surgery
Infective endocarditis
Opioid crisis
People who inject drugs
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