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Randomized Controlled Trial
. 2006 Sep 11:6:137.
doi: 10.1186/1471-2334-6-137.

Clinical manifestations and outcome in Staphylococcus aureus endocarditis among injection drug users and nonaddicts: a prospective study of 74 patients

Eeva Ruotsalainen  1 , Kari Sammalkorpi, Janne Laine, Kaisa Huotari, Seppo Sarna, Ville Valtonen, Asko Järvinen
Affiliations
Randomized Controlled Trial

Clinical manifestations and outcome in Staphylococcus aureus endocarditis among injection drug users and nonaddicts: a prospective study of 74 patients

Eeva Ruotsalainen et al. BMC Infect Dis. .

Abstract

Background: Endocarditis is a common complication in Staphylococcus aureus bacteremia (SAB). We compared risk factors, clinical manifestations, and outcome in a large, prospective cohort of patients with S. aureus endocarditis in injection drug users (IDUs) and in nonaddicts.

Methods: Four hundred and thirty consecutive adult patients with SAB were prospectively followed up for 3 months. Definite or possible endocarditis by modified Duke criteria was found in 74 patients: 20 patients were IDUs and 54 nonaddicts.

Results: Endocarditis was more common in SAB among drug abusers (46%) than in nonaddicts (14%) (odds ratio [OR], 5.12; 95% confidence interval [CI], 2.65-9.91; P < 0.001). IDUs were significantly younger (27 +/- 15 vs 65 +/- 15 years, P < 0.001), had less ultimately or rapidly fatal underlying diseases (0% vs 37%, P < 0.001) or predisposing heart diseases (20% vs 50%, P = 0.03), and their SAB was more often community-acquired (95% vs 39%, P < 0.001). Right-sided endocarditis was observed in 60% of IDUs whereas 93% of nonaddicts had left-sided involvement (P < 0.001). An extracardiac deep infection was found in 85% of IDUs and in 89% of nonaddicts (P = 0.70). Arterial thromboembolic events and severe sepsis were also equally common in both groups. There was no difference in mortality between the groups at 7 days, but at 3 months it was lower among IDUs (10%) compared with nonaddicts (39%) (OR, 5.73; 95% CI, 1.20-27.25; P = 0.02).

Conclusion: S. aureus endocarditis in IDUs was associated with as high complication rates including extracardiac deep infections, thromboembolic events, or severe sepsis as in nonaddicts. Injection drug abuse in accordance with younger age and lack of underlying diseases were associated with lower mortality, but after adjusting by age and underlying diseases injection drug abuse was not significantly associated with mortality.

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References

    1. Miro JM, Anguera I, Cabell CH, Chen AY, Stafford JA, Corey GR, Olaison L, Eykyn S, Hoen B, Abrutyn E, Raoult D, Bayer A, Fowler VGJ. Staphylococcus aureus native valve infective endocarditis: report of 566 episodes from the International Collaboration on Endocarditis Merged Database. Clin Infect Dis. 2005;41:507–514. doi: 10.1086/431979. - DOI - PubMed
    1. Fowler VGJ, Miro JM, Hoen B, Cabell CH, Abrutyn E, Rubinstein E, Corey GR, Spelman D, Bradley SF, Barsic B, Pappas PA, Anstrom KJ, Wray D, Fortes CQ, Anguera I, Athan E, Jones P, van der Meer JT, Elliott TS, Levine DP, Bayer AS. Staphylococcus aureus endocarditis: a consequence of medical progress. Jama. 2005;293:3012–3021. doi: 10.1001/jama.293.24.3012. - DOI - PubMed
    1. Mylonakis E, Calderwood SB. Infective endocarditis in adults. N Engl J Med. 2001;345:1318–1330. doi: 10.1056/NEJMra010082. - DOI - PubMed
    1. Mirimanoff RO, Glauser MP. Endocarditis during Staphylococcus aureus septicemia in a population of non-drug addicts. Arch Intern Med. 1982;142:1311–1313. doi: 10.1001/archinte.142.7.1311. - DOI - PubMed
    1. Hedstrom SA, Christensson B. Staphylococcus aureus septicaemia and endocarditis at the University Hospital in Lund 1976-1980. Scand J Infect Dis Suppl. 1983;41:38–48. - PubMed

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