Table 1.
Demographic and clinical characteristics of entire cohort
| Stimulant use only (n=24) n (%) or mean (SD) |
Opioid use only (n=71) n (%) or mean (SD) |
Both stimulant and opioid use (n=166) n (%) or mean (SD) |
All injection drug use (n=290) n (%) or mean (SD) |
||
| Age at admission | Mean (SD) | 38.2 (10.9) | 37.1 (9.8) | 33.7 (9.0) | 35.1 (9.8) |
| Sex | Female | 12 (50) | 34 (48) | 90 (54) | 143 (49) |
| Male | 12 (50) | 37 (52) | 76 (46) | 147 (51) | |
| HIV status | Negative | 17 (71) | 53 (75) | 117 (70) | 207 (71) |
| Positive | 1 (4.2) | 8 (11) | 20 (12) | 29 (10) | |
| Unknown | 6 (25) | 10 (14) | 29 (17) | 54 (19) | |
| Hepatitis C status | Negative | 5 (21) | 17 (24) | 24 (14) | 54 (19) |
| Positive | 16 (67) | 48 (68) | 128 (77) | 208 (72) | |
| Unknown | 3 (12) | 6 (8.5) | 14 (8.4) | 28 (9.7) | |
| Homeless | No | 20 (83) | 64 (90) | 132 (80) | 241 (83) |
| Yes | 4 (17) | 7 (9.9) | 34 (20) | 49 (17) | |
| Site of IE | Right side | 11 (46) | 47 (66) | 114 (69) | 180 (62) |
| Left side | 11 (46) | 17 (24) | 35 (21) | 79 (27) | |
| Bilateral | 2 (8.3) | 4 (5.6) | 12 (7.2) | 22 (7.6) | |
| Unknown* | 0 (0) | 3 (4.2) | 5 (3.0) | 9 (3.1) | |
| Vegetation valve or site† | Aortic | 9 (38) | 16 (23) | 13 (7.8) | 49 (17) |
| Mitral | 5 (21) | 7 (9.9) | 35 (21) | 60 (21) | |
| Tricuspid | 12 (50) | 50 (70) | 123 (74) | 198 (68) | |
| Pulmonic | 0 (0) | 2 (2.8) | 2 (1.2) | 4 (1.4) | |
| Non-valvular‡ | 0 (0) | 0 (0) | 1 (0.6) | 2 (0.7) | |
| Unknown* | 0 (0) | 3 (4.2) | 5 (3.0) | 9 (3.1) | |
| Congenital heart disease§ | Yes | 0 (0) | 0 (0) | 1 (0.6) | 1 (0.3) |
| Other valve disease¶ | Yes | 1 (4.2) | 0 (0) | 2 (1.2) | 4 (1.4) |
| Echocardiogram performed | Both TTE** and TEEπ | 14 (58) | 38 (54) | 73 (44) | 136 (47) |
| TTE** only | 10 (42) | 32 (45) | 93 (56) | 152 (52) | |
| None | 0 (0) | 1 (1.4) | 0 (0) | 2 (0.7) | |
| Cardiac complications† | Myocardial abscess | 1 (4.2) | 4 (5.6) | 7 (4.2) | 14 (4.8) |
| Aortic root abscess | 1 (4.2) | 3 (4.2) | 4 (2.4) | 10 (3.4) | |
| Heart failure | 4 (17) | 15 (21) | 21 (13) | 47 (16) | |
| Conduction delay | 3 (12) | 1 (1.4) | 1 (0.6) | 6 (2.1) | |
| Vascular complications† | Ischaemic stroke | 5 (21) | 10 (14) | 21 (13) | 46 (16) |
| Intracerebral haemorrhage | 2 (8.3) | 6 (8.5) | 9 (5.4) | 24 (8.3) | |
| Mycotic aneurysm | 1 (4.2) | 3 (4.2) | 5 (3.0) | 13 (4.5) | |
| Septic pulmonary emboli | 10 (42) | 44 (62) | 110 (66) | 177 (61) | |
| Hepatic infarct | 0 (0) | 2 (2.8) | 0 (0) | 4 (1.4) | |
| Mesenteric ischaemia | 0 (0) | 1 (1.4) | 0 (0) | 2 (0.7) | |
| Renal infarct | 0 (0) | 4 (5.6) | 0 (0) | 14 (4.8) | |
| Limb ischaemia | 0 (0) | 0 (0) | 0 (0) | 2 (0.7) | |
| Invasive infection† | CNS infection†† | 3 (12) | 6 (8.5) | 14 (8.4) | 29 (10) |
| Septic arthritis | 2 (8.3) | 7 (9.9) | 21 (13) | 32 (11) | |
| Osteomyelitis | 2 (8.3) | 5 (7.0) | 15 (9.0) | 25 (8.6) | |
| Secondary bacteraemia‡‡ | Yes | 1 (4.2) | 22 (31) | 36 (22) | 58 (20) |
| Antimicrobial treatment | Wholly inpatient, wholly IV | 11 (46) | 41 (58) | 94 (56) | 162 (56) |
| Wholly inpatient, part oral | 0 (0) | 7 (9.9) | 18 (11) | 26 (9.0) | |
| Part outpatient, wholly IV | 11 (46) | 19 (27) | 31 (19) | 72 (25) | |
| Part outpatient, part IM | 0 (0) | 0 (0) | 2 (1.2) | 2 (0.7) | |
| Part outpatient, part oral | 2 (8.3) | 4 (5.6) | 21 (13) | 28 (9.7) | |
| Surgical treatment† | Any surgical intervention | 6 (25) | 16 (23) | 17 (10) | 49 (17) |
| Device insertion or removal | 1 (4.2) | 4 (5.6) | 5 (3.0) | 5 (1.7) | |
| Valve repair | 5 (21) | 9 (13) | 12 (7.2) | 32 (11) | |
| Valve replacement, any | 3 (12) | 11 (15) | 4 (2.4) | 25 (8.6) | |
| Valve replacement, biologic | 1 (4.2) | 8 (11) | 4 (2.4) | 17 (5.8) | |
| Valve replacement, mechanical | 2 (8.3) | 3 (4.2) | 0 (0.0) | 9 (3.1) | |
| Valve repair and replacement | 2 (8.3) | 4 (5.6) | 1 (0.6) | 10 (3.4) | |
| Length of stay | Mean days (SD) | 21.5 (18.1) | 32.4 (23.8) | 31.7 (23.9) | 29.7 (23.1) |
| Left against medical advice | Yes | 4 (17) | 10 (14) | 46 (28) | 62 (21) |
| Opiate used§§ | Hydromorphone IR¶¶ | 0 (0) | 51 () | 120 () | 171 (59***) |
| Hydromorphone CRχ | 0 (0) | 21 () | 32 | 53 (18***) | |
| Morphine | 0 (0) | 11 (15) | 35 (21) | 46 (16***) | |
| Fentanyl | 0 (0) | 5 (7.0) | 7 (4.2) | 12 (4.1***) | |
| Heroin | 0 (0) | 3 (4.2) | 11 (6.6) | 14 (4.8***) | |
| Oxycodone | 0 (0) | 14 (20) | 22 (13) | 36 (12***) | |
| Oxycodone-acetaminophen | 0 (0) | 4 (5.6) | 5 (3.0) | 9 (3.1***) | |
| Stimulant used§§ | Methamphetamine | 18 (75) | 0 (0) | 131 (79) | 149 (51●) |
| Cocaine | 10 (42) | 0 (0) | 68 (41) | 78 (27***) | |
| Crack | 4 (17) | 0 (0) | 14 (8.4) | 28 (9.7***) | |
| Bupropion | 1 (4.2) | 0 (0) | 1 (0.6) | 2 (0.7***) | |
| Methylphenidate | 3 (12) | 0 (0) | 18 (11) | 21 (7.2***) | |
| Addictions counselling referral | Yes | 6 (25) | 29 (41) | 66 (40) | 103 (56) |
| Opioid substitution therapy††† | Yes | 7 (29) | 11 (15) | 27 (16) | 48 (17) |
| Death | No | 18 (75) | 49 (69) | 127 (77) | 209 (72) |
| Yes, during this episode | 5 (21) | 9 (13) | 18 (11) | 43 (15) | |
| Yes, during full follow-up period | 6 (25) | 22 (31) | 39 (23) | 81 (28) | |
| Microbiology† | Staphylococcus aureus | 18 (75) | 58 (82) | 151 (91) | 245 (84) |
| MSSA | 15 (62) | 43 (61) | 113 (68) | 184 (63) | |
| MRSA | 3 (12) | 15 (21) | 38 (23) | 61 (21) | |
| Viridans-group strep | 3 (12) | 2 (2.8) | 10 (6.0) | 19 (6.6) | |
| Non-viridans strep | 1 (4.2) | 3 (4.2) | 5 (3.0) | 12 (4.1) | |
| Enterococci (all Enterococcus faecalis) | 3 (12) | 4 (5.6) | 5 (3.0) | 17 (5.9) | |
| Enterobacterales | 1 (4.2) | 2 (2.8) | 0 (0) | 5 (1.7) | |
| Pseudomonas or acinetobacter | 0 (0) | 0 (0) | 4 (2.4) | 4 (1.4) | |
| Bartonella henselae | 0 (0) | 1 (1.4) | 1 (0.6) | 2 (0.7) | |
| Burkholderia cepacia | 0 (0) | 1 (1.4) | 0 (0) | 1 (0.3) | |
| Actinomyces odontolyticus | 1 (4.2) | 0 (0) | 0 (0) | 1 (0.3) | |
| Candida albicans | 0 (0) | 1 (1.4) | 1 (0.6) | 2 (0.7) | |
| Polymicrobial | 3 (12) | 5 (7.0) | 14 (8.4) | 22 (7.6) | |
| Culture negative | 0 (0) | 2 (2.8) | 4 (2.4) | 6 (2.1) | |
*Definite endocarditis by modified Duke criteria with no evidence of vegetation on echocardiogram.
†Sum to more than 100% because the categories are not mutually exclusive.
‡Includes atrial and right ventricular vegetations.
§Single included patient with congenital heart disease had coarctation of the aorta, without prosthesis.
¶All patients with underlying valvular disease had bicuspid aortic valves. The patient with coarctation also had bicuspid valve and is included in this count. We note that the patient who injected only stimulants and had a bicuspid aortic valve was diagnosed with mitral valve endocarditis.
**Transthoracic echocardiogram π transoesophageal echocardiogram.
††CNS infection, including meningitis, brain abscess, epidural abscess or paraspinal abscess; septic emboli leading to stroke are captured separately as ‘ischaemic stroke’ above.
‡‡As defined in Tan et al24 identification of a microorganism in blood culture, not secondary to an infection at another body site, different from that grown on index blood cultures at the time of infective endocarditis diagnosis; obtained at least 48 hours after index blood cultures and while the patient was receiving parenteral antimicrobials; not associated with a new vegetation; presumed to be due to direct inoculation.
§§Use within 3 months of admission.
¶¶Hydromorphone immediate release, most commonly sold by brand name dilaudidχhydromorphone controlled release, most commonly sold by brand name Hydromorph Contin.
***Percentages are of known use among all patients; denominator includes 29 patients with unknown substance use.
†††Methadone, suboxone, naloxone.
CNS, central nervous system; CRχ, continuous-release; IM, intramuscular; IR, immediate-release; IV, intravenous; MRSA, Methicillin-resistant Staphylococcus aureus; MSSA, Methicillin sensitive Staphylococcus aureus.