Clinical Prognosis of Right-Sided Infective Endocarditis not Associated with Cardiac Devices or Intravenous Drug use: a Cohort Study and Meta-Analysis

Abstract Background Pure right-sided infective endocarditis (RSIE) without association with cardiac devices or intravenous drug users (IVDUs) is an entity with unclear predisposing factors and prognosis. Purpose To evaluate predisposing factors and prognosis of pure RSIE compared tothose associated to cardiac devices or IVDUs. Methods 280 consecutive patients with endocarditis were included retrospectively in a protocol of clinical and imaging follow-up. Endocarditis-related event was defined as endocarditis mortality or open-surgery requirement. Besides, a review and meta-analysis of the literature between january 2000 and december 2018 were performed. Results Fifty-two (19%) patients presented RSIE: 20 of them (39%) were pure RSIE. Intravascular catheters carriers (25% vs 3%; p=0.026) and congenital heart diseases (20% vs 0%; p=0.018) were associated to pure RSIE. These patients demonstrated the worst clinical prognosis, with the highest in-hospital mortality (25% vs 3%; p=0.026) and endocarditis-related event rate (45% vs 6%; p=0.001), being pure RSIE independently associated with in-hospital endocarditis-related events (OR=8.40; 95% CI, 1.13–62.68; p=0.038). Four studies, including ours, with 315 participants diagnosed of RSIE were evaluated in meta-analysis: 94 individuals (30%) presented pure RSIE.This group demonstrated a higher in-hospital mortality than those with cardiac devices or IVDUs (RR=2.854; 95% CI, 1.640–4.965; P<0.001; I2=0.0%; Figure 1). Figure 1. RSIE and in-hospital mortality based on groups: cases with pure RSIE versus those with cardiac devices or IVDUs. Conclusions Pure RSIE is the worst prognosis group among RSIE with the highest endocarditis-related event rate and in-hospital mortality. This growing group should stake out the benign impression and recommendations given to RSIE among IE patients.

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Endocarditis and the impact of intravenous drug use: a cohort study

Infectious Diseases ◽

10.1080/23744235.2021.1928279 ◽

2021 ◽

pp. 1-7

Author(s):

Christopher H. D. Lawrence ◽

James Cheaveau ◽

Michalis Kavourides ◽

David Chadwick ◽

Brendan McCarron

Keyword(s):

Cohort Study ◽

Drug Use ◽

Intravenous Drug ◽

Intravenous Drug Use ◽

The Impact

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The Lived Experience of Nurses Caring for Patients Diagnosed With Intravenous Drug Use–Associated Infective Endocarditis in Appalachia: A Phenomenological Study

Journal of the American Psychiatric Nurses Association ◽

10.1177/10783903211037735 ◽

2021 ◽

pp. 107839032110377

Author(s):

Kendrea L. Todt ◽

Sandra P. Thomas

Keyword(s):

Substance Use ◽

Infective Endocarditis ◽

Drug Use ◽

Substance Use Disorder ◽

Phenomenological Study ◽

Care Delivery ◽

Intravenous Drug ◽

Intravenous Drug Use ◽

Central Theme ◽

Number Of Patients

BACKGROUND: The number of patients admitted with infective endocarditis (IE) from intravenous drug use (IVDU) in Appalachia is increasing, a direct downstream effect of the opioid crisis. Extant literature highlights the pejorative attitudes health care workers have toward patients with substance use disorder, with nurses among the most punitive. Rather than describe attitudes, the purpose of this study was to describe the lived experiences of nurses caring for patients diagnosed with IE from IVDU in Appalachia. OBJECTIVE: To describe an unexplored phenomenon in Appalachia to inform nursing practice, nursing education, and health policy. METHOD: Qualitative phenomenological study using the University of Tennessee method based on the tenets of Maurice Merleau-Ponty. Nine nurses (ages 29-53 years) recruited using purposive and snowball sampling participated in unstructured phenomenological interviews. RESULTS: The essential meaning or central theme of the nurse experience working with these patients was a sense of hopelessness/hope, with four interrelated themes derived from the central theme: (1) guarding/escaping, (2) responsibility and revulsion, (3) apathy/empathy, and (4) grief and sorrow/cold and unemotional. Universally, nurses perceived caring for this population as futile, feeling a sense of powerlessness to change the outcome. CONCLUSIONS: These care experiences frustrated nurses, who described being physically and emotionally drained. To improve care delivery and improve patient outcomes, emphasis must be placed on nurse addiction education and standardizing nurse to patient with substance use disorder ratios to decrease work-related stress on nurses.

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Drug use-related right-sided infective endocarditis complicated by empyema and bronchopleural fistula

BMJ Case Reports ◽

10.1136/bcr-2021-246663 ◽

2022 ◽

Vol 15 (1) ◽

pp. e246663

Author(s):

Lindsey M Shain ◽

Taha Ahmed ◽

Michele L Bodine ◽

Jennifer G Bauman

Keyword(s):

Infective Endocarditis ◽

Drug Use ◽

Bronchopleural Fistula ◽

Disease Process ◽

Intravenous Drug ◽

Pulmonary Emboli ◽

Intravenous Drug Use ◽

Respiratory Complications

Right-sided infective endocarditis is frequently accompanied by septic pulmonary emboli, which may result in a spectrum of respiratory complications. We present the case of a 25-year-old woman diagnosed with infective endocarditis secondary to intravenous drug use. During a long and arduous hospital course, the patient developed empyema with bronchopleural fistula, representing severe but uncommon sequelae that may arise from this disease process. She was treated with several weeks of antibiotics as well as surgical thorascopic decortication and parietal pleurectomy.

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75 Infective endocarditis and intravenous drug use: a descriptive study

10.1136/heartjnl-2018-bcs.75 ◽

2018 ◽

Author(s):

Sam Straw ◽

Wazir Baig ◽

Richard Gillott ◽

Francesco Pirone ◽

Jonathan Sandoe

Keyword(s):

Infective Endocarditis ◽

Drug Use ◽

Descriptive Study ◽

Intravenous Drug ◽

Intravenous Drug Use

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A Case ofSerratia marcescensEndocarditis in a Nonintravenous Drug-Using Male Patient and Review of Literature

Case Reports in Infectious Diseases ◽

10.1155/2019/3715404 ◽

2019 ◽

Vol 2019 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Achilleas Nikolakopoulos ◽

Nikolaos Koutsogiannis ◽

Panagiota Xaplanteri ◽

Charalambos Gogos ◽

Fevronia Kolonitsiou ◽

...

Keyword(s):

Infective Endocarditis ◽

Drug Use ◽

Serratia Marcescens ◽

Male Patient ◽

Intravenous Drug ◽

Medical Procedure ◽

Intravenous Drug Use ◽

Chordae Tendineae ◽

Hospital Acquired Infections ◽

Hospital Acquired

Introduction.Serratia marcescensis a rare cause of infective endocarditis and has almost exclusively been associated with intravenous drug use and hospital-acquired infections. Here, we present a case of infective endocarditis caused bySerratia marcescensin an otherwise healthy, nonintravenous drug-using male patient.Case Report. A 41-year-old man presented with hypertension and hemoptysis. Blood cultures were obtained that showed bacteremia bySerratia marcescens. An echocardiogram was carried out that revealed severe mitral regurgitation accompanying ruptured mitral chordae tendineae. The patient received the appropriate antibiotic treatment, without further surgical intervention.Discussion.Hospital-acquired infections bySerratiaspecies are a common problem in medical practice and have been attributed to specialized interventional procedures. Taking into consideration the patient’s immunocompetence and lack of intravenous drug use, it is possible that bacteremia could be attributed to a medical procedure. Moreover, in contrast to most cases described in the literature, no surgery was performed.

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Hemothorax due to Ruptured Mycotic Aneurysm of Intercostal Arteries Associated with Infective Endocarditis

Case Reports in Medicine ◽

10.1155/2017/9213514 ◽

2017 ◽

Vol 2017 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Eddie Y. Liu ◽

Jennifer Crawford ◽

Haissam Haddad

Keyword(s):

Staphylococcus Aureus ◽

Infective Endocarditis ◽

Drug Use ◽

Mycotic Aneurysm ◽

Rare Complication ◽

Intravenous Drug ◽

Intravenous Drug Use ◽

Methicillin Resistant

We present a case of hemothorax due to ruptured mycotic aneurysm in three intercostal arteries in a 40-year-old male with methicillin-resistant Staphylococcus aureus infective endocarditis (IE) due to intravenous drug use. Microcoil embolization and thoracotomy successfully achieved hemostasis. Mycotic aneurysm is a rare complication of IE and is usually found in the intracranial vessels. Ruptured mycotic aneurysm in the intercostal arteries can be associated with IE and can present as acute hemothorax.

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