Risk Factors Of Infective Endocarditis In Persons Who Inject Drugs

Abstract Background: The rising incidence of infective endocarditis (IE) among people who inject drugs (PWID) has been a major concern across North America. Details of injection practices leading to IE are not well characterized.Methods: A case-control study, using one-on-one interviews to understand risk factors and injection practices associated with IE among PWID was conducted. Eligible participants included those who had injected drugs within the last 3 months, were > 18 years old and either never had or were currently admitted for an IE episode. Cases were recruited from the tertiary care centers and controls were recruited from outpatient clinics in patients without IE and addiction clinics in London, Ontario. Results: 33 cases (PWID IE+) and 102 controls (PWID but IE-) were interviewed. Using clean injection equipment from the provincial distribution network was a protective factor against IE (p<0.001). Furthermore, using lighters during the injection process was also protective for IE (OR 2.5; 95% CI 1.11–5.63). Female sex (OR 3.63; 95% CI 1.58-8.36) and injection into multiple sites (OR 4.31; 95% CI 1.33-13.93) were associated with IE. Injection into the feet (57.6% cases; 36.6% control; p= 0.034) was also associated with IE. Discussion: Our pilot study highlights the importance of distributing clean injection materials for IE prevention. Injection into multiple areas may indicate a greater difficulty in accessing common and safer injection sites such as the arm, and thus multi-site injections may be a surrogate marker for injection-related venous damage in entrenched drug users. Moreover, the use of lighters may be correlated with the best practice of heating preparations of drugs prior to injection, which is known to reduce bacterial burden. Lastly, gender differences in injection techniques, which may place women at higher risk of IE, requires further study.

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Risk Factors of Infective Endocarditis in Persons Who Inject Drugs

10.21203/rs.2.22402/v2 ◽

2020 ◽

Author(s):

Meera Shah ◽

Ryan Wong ◽

Laura Ball ◽

Klajdi Puka ◽

Charlie Tan ◽

...

Keyword(s):

Risk Factors ◽

Infective Endocarditis ◽

Tertiary Care ◽

Distribution Networks ◽

Persons Who Inject Drugs ◽

High Prevalence ◽

Injection Techniques ◽

Tertiary Care Centers ◽

Injection Materials ◽

Injection Practices

Abstract Background: The rising incidence of infective endocarditis (IE) among people who inject drugs (PWID) has been a major concern across North America. The coincident rise in IE and change of drug preference to hydromorphone-controlled release (CR) among our PWID population in London, Ontario, intrigued us to study the details of injection practices leading to IE, which have not been well characterized in literature. Methods: A case-control study, using one-on-one interviews to understand risk factors and injection practices associated with IE among PWID was conducted. Eligible participants included those who had injected drugs within the last 3 months, were >18 years old and either never had or were currently admitted for an IE episode. Cases were recruited from the tertiary care centers and controls without IE were recruited from outpatient clinics and addiction clinics in London, Ontario. Results: 33 cases (PWID IE+) and 102 controls (PWID but IE-) were interviewed. Multivariable logistic regressions showed that the odds of having IE were 4.65 times higher among females (95% CI 1.85, 12.28; p=.001), and 5.76 times higher among PWID who did not use clean injection equipment from the provincial distribution networks (95% CI 2.37, 14.91; p<.001). Injecting into multiple sites and heating hydromorphone-CR prior to injection were not found to be significantly associated with IE. Hydromorphone-CR was the most commonly injected drug in both groups (90.9% cases; 81.4% controls, p = 0.197). Discussion: Our study highlights the importance of distributing clean injection materials for IE prevention. Furthermore, our study showcases that females are at higher risk of IE, which is contrary to the reported literature. Gender differences in injection techniques, which may place women at higher risk of IE, require further study. We suspect that the very high prevalence of hydromorphone-CR use made our sample size too small to identify a significant association between its use and IE, which has been established in the literature.

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POS-592 RISK FACTORS FOR MORTALITY AFTER INFECTIVE ENDOCARDITIS IN CHRONIC HEMODIALYSIS PATIENTS IN A TERTIARY CARE CENTER

Kidney International Reports ◽

10.1016/j.ekir.2021.03.621 ◽

2021 ◽

Vol 6 (4) ◽

pp. S259-S260

Author(s):

J.I. Lara-Prado ◽

M.I. Gil Arredondo

Keyword(s):

Risk Factors ◽

Infective Endocarditis ◽

Care Center ◽

Tertiary Care ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Tertiary Care Center

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A retrospective epidemiologic study to define risk factors, microbiology, and clinical outcomes of infective endocarditis in a large tertiary-care teaching hospital

SAGE Open Medicine ◽

10.1177/2050312117741772 ◽

2017 ◽

Vol 5 ◽

pp. 205031211774177 ◽

Cited By ~ 10

Author(s):

Anahita S Mostaghim ◽

Hoi Yee Annie Lo ◽

Nancy Khardori

Keyword(s):

Risk Factors ◽

Infective Endocarditis ◽

Clinical Outcomes ◽

Teaching Hospital ◽

Tertiary Care ◽

Epidemiologic Study ◽

Tertiary Care Teaching Hospital ◽

Care Teaching ◽

Large Tertiary Care

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Brucella Endocarditis in Persons Who Inject Drugs

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa063 ◽

2020 ◽

Vol 7 (4) ◽

Author(s):

John M Cafardi ◽

Douglas Haas ◽

Thomas Lamarre ◽

Judith Feinberg

Keyword(s):

Infective Endocarditis ◽

Drug Use ◽

Injection Drug Use ◽

Injection Drug Users ◽

Drug Users ◽

Cardiac Involvement ◽

Injection Drug ◽

Persons Who Inject Drugs ◽

Brucella Infection

Abstract We report 2 cases of infective endocarditis in injection drug users due to Brucella infection. Although cardiac involvement is a frequent sequela of brucellosis and endocarditis is often seen with injection drug use, Brucella endocarditis in persons who inject drugs without zoonotic exposure has not been reported to date.

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Characterization, epidemiological profile and risk factors for clinical outcome of infective endocarditis from a tertiary care centre in Turkey

Infectious Diseases ◽

10.1080/23744235.2019.1646431 ◽

2019 ◽

Vol 51 (10) ◽

pp. 738-744 ◽

Cited By ~ 2

Author(s):

Hicaz Zencirkiran Agus ◽

Serkan Kahraman ◽

Cagdas Arslan ◽

Gamze Babur Guler ◽

Ali Kemal Kalkan ◽

...

Keyword(s):

Risk Factors ◽

Infective Endocarditis ◽

Clinical Outcome ◽

Tertiary Care ◽

Care Centre ◽

Tertiary Care Centre ◽

Epidemiological Profile

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Risk Factors Associated With Outcomes of Non-cardioembolic Ischemic Stroke In Patients Stratified By Essen Stroke Risk Score

10.21203/rs.2.22244/v1 ◽

2020 ◽

Author(s):

Yanting Ping Ping ◽

Qianqian Yang Yang ◽

Yuwen Huang Huang ◽

Huimin Xu Xu ◽

Haibin Dai

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Risk Score ◽

Protective Factor ◽

Stroke Risk ◽

Recurrent Stroke ◽

Univariate Analysis ◽

Tertiary Care ◽

Vascular Events ◽

Stroke Outcomes

Abstract Background: Identifying risk factors of cardiovascular events is crucial for stroke prevention and they can be used as predictive factors of stroke outcomes.In this study, it is to evaluate the risk factors that predict outcomes of acute non-cardioembolic ischemic stroke in patients stratified by Essen Stroke Risk Score (ESRS). Methods: A retrospective study was carried out in acute non-cardioembolic ischemic stroke patients in a Chinese tertiary-care teaching hospital. ESRS stratification and factors that might influence the outcomes of stroke, as indicated by fatal or non-fatal combined vascular events of recurrent stroke, myocardial infarction, or primary intracranial hemorrhage, were documented. Univariate analysis and multivariable regression analysis was used to identify independent predictors of stroke outcomes. Results: A total of 878 patients with acute non-cardioembolic ischemic stroke who completed a mean follow-up of 5.2 years were enrolled, and 163 patients experienced at least one component of the combined vascular event. In patients with an ESRS ≤ 3, age ≥ 65 years (OR , 2.935; 95% CI 1.625-5.301, P < 0.001) and clopidogrel treatment (OR , 1.685 ; 95% CI , 1.026-2.768; P = 0.041) were significantly associated with stroke outcomes. In patients with an ESRS > 3, age ≥ 65 years (OR , 2.107, 95% CI , 1.208-3.673 ; P = 0.008) and history of diabetes (OR , 1.465 ; 95% CI , 1.041–2.062 ; P = 0.027) were risk factors for stroke outcomes , whereas clopidogrel treatment (OR , 0.542; 95% CI , 0.356–0.824; P = 0.003) was a protective factor for stroke outcomes. Conclusions: According to this study, clopidogrel treatment, blood pressure control, and glycemic control are protective factors for stroke outcomes in high-risk patients (ESRS>3).

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Incidence and Risk Factors of Ocular Infection Caused by Staphylococcus aureus Bacteremia

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.02651-15 ◽

2016 ◽

Vol 60 (4) ◽

pp. 2012-2017 ◽

Cited By ~ 8

Author(s):

Jiwon Jung ◽

Junyeop Lee ◽

Shi Nae Yu ◽

Yong Kyun Kim ◽

Ju Young Lee ◽

...

Keyword(s):

Risk Factors ◽

Staphylococcus Aureus ◽

Infective Endocarditis ◽

Tertiary Care ◽

Ocular Infection ◽

Ocular Involvement ◽

Care Hospital ◽

Content Type ◽

Ocular Infections ◽

Metastatic Infection

ABSTRACTStaphylococcus aureusbacteremia (SAB) often leads to ocular infections, including endophthalmitis and chorioretinitis. However, the incidence, risk factors, and outcomes of ocular infections complicated by SAB are largely unknown. We retrospectively analyzed the incidence and risk factors of ocular involvement in a prospective cohort of patients with SAB at a tertiary-care hospital. Ophthalmologists reviewed the fundoscopic findings and classified the ocular infections as endophthalmitis or chorioretinitis. During the 5-year study period, 1,109 patients had SAB, and data for 612 (55%) who underwent ophthalmic examinations within 14 days after SAB onset were analyzed. Of those 612 patients, 56 (9% [95% confidence interval [CI], 7 to 12%]) had ocular involvement, including 15 (2.5%) with endophthalmitis and 41 (6.7%) with chorioretinitis. In a multivariate analysis, infective endocarditis (adjusted odds ratio [aOR], 5.74 [95% CI, 2.25 to 14.64]) and metastatic infection (aOR, 2.38 [95% CI, 1.29 to 4.39]) were independent risk factors for ocular involvement. Of the 47 patients with ocular involvement who could communicate, only 17 (36%) had visual disturbances. Two-thirds of the patients with endophthalmitis (10/15 patients) were treated with intravitreal antibiotics combined with parenteral antibiotics, whereas all of the patients with chorioretinitis were treated only with systemic antibiotics. No patients became blind. Among 42 patients for whom follow-up assessments were available, the ocular lesions improved in 29 (69%) but remained the same in the others. Ocular involvement was independently associated with death within 30 days after SAB onset. Ocular involvement is not uncommon among patients with SAB. Routine ophthalmic examinations should be considered for patients with infective endocarditis or metastatic infections caused by SAB.

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Methicillin Resistance and Risk Factors for Embolism inStaphylococcus aureusInfective Endocarditis

Infection Control and Hospital Epidemiology ◽

10.1086/518727 ◽

2007 ◽

Vol 28 (7) ◽

pp. 860-866 ◽

Cited By ~ 11

Author(s):

Ron-Bin Hsu ◽

Fang-Yue Lin

Keyword(s):

Risk Factors ◽

Infective Endocarditis ◽

Methicillin Resistance ◽

Tertiary Care ◽

Retrospective Chart Review ◽

Neurological Involvement ◽

Hospital Death ◽

Care Hospital ◽

Methicillin Resistant ◽

Independent Risk Factors

Objective.Infective endocarditis caused byStaphylococcus aureusis an ominous prognosis associated with a high prevalence of embolic episodes and neurological involvement. Whether methicillin resistance decreases the risk of embolism in infective endocarditis is unclear. We sought to assess the association between methicillin resistance and risk factors for embolism in S.aureusinfective endocarditis.Design.Retrospective chart review. Data from patients with infective endocarditis due to methicillin-resistantS. aureus werecompared with data from patients with endocarditis due to methicillin-susceptibleS. aureus.Logistic regression was used to identify independent risk factors for embolism.Setting.A 2,000-bed, university-affiliated tertiary care hospital.Patients.Between 1995 and 2005, 123 patients withS. aureusinfective endocarditis were included in the study. There were 74 male patients and 49 female patients, with a median age of 54 years (range, 0-89 years).Results.Of 123 infections, 30 (24%) were nosocomial infections, and 14 (11%) were prosthetic valve infections. Of 123S. aureusisolates, 48 (39%) were methicillin resistant. In total, embolism occurred in 45 (37%) of these patients: pulmonary embolism in 22 (18%), cerebral embolism in 21 (17%), and peripheral embolism in 6 (5%). The independent risk factors for an embolism were injection drug use, presence of a cardiac vegetation with a size of 10 mm or greater, and absence of nosocomial infection. For 83 patients with aortic or mitral infective endocarditis, independent risk factors for an embolism were the presence of a cardiac vegetation with a size of 10 mm or greater and endocarditis due to methicillin-susceptibleS. aureus.Overall, in-hospital death occurred for 32 (26%) of 123 Patients. Methicillin-resistant infection was not an independent risk factor for death.Conclusions.Methicillin-resistant S.aureusinfection was associated with decreased risk of embolism in left-side endocarditis, but was not associated with in-hospital death.

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