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. 2016 Dec;352(6):609-614.
doi: 10.1016/j.amjms.2016.10.002. Epub 2016 Oct 18.

Endocarditis as a Marker for New Epidemics of Injection Drug Use

Susana Williams Keeshin  1 , Judith Feinberg  2
Affiliations

Endocarditis as a Marker for New Epidemics of Injection Drug Use

Susana Williams Keeshin et al. Am J Med Sci. 2016 Dec.

Abstract

Background: We examined discharges for infective endocarditis (IE) at an academic teaching hospital for over 10 years to evaluate if an increase in hospitalizations for IE and increase in hepatitis C virus (HCV) in patients with IE could predict a new epidemic of injection drug use (IDU).

Materials and methods: Retrospective medical record review of discharged patients with the diagnosis of IE as defined by the modified Duke criteria. Student's t test, chi-squared test and Fisher's exact test were used to calculate P values.

Results: There were 542 discharges among 392 unique patients with IE and 104 patients were readmitted 2-7 times. Of the total discharges, 367 (67.7%) were not screened for HCV, and of those tested, 86 (49.1%) were HCV+; 404 (74.5%) were not screened for HIV and of those tested, 28 (20.3%) were HIV+. Patients who self-identify as a person who injects drugs were more likely to be tested for HCV, 75 (69.4%) versus 12 (31.5%, P < 0.0001), and for HIV, 72 (66.6%) versus 13 (34.2%, P < 0.0001) compared with those who self-report no IDU. Those with a positive result for opiate or heroin toxicology test were more likely to be screened for HCV, 70 (66%) versus 22 (44.8%, P < 0.0001), and for HIV, 66 (62.2%) versus 25 (51%, P < 0.0001) than those with negative result for toxicology test. Over this period, there was a 2-fold increase in IE cases, a 3-fold increase in HCV antibody prevalence and a 6-fold increase in opiate toxicology screens showing positive result, but no increase in HIV.

Conclusions: Although IDU is a known risk factor for IE, the observation of a sharp increase in IE cases may signal a new epidemic of IDU and HCV.

Keywords: Endocarditis; Hepatitis C virus; Human immunodeficiency virus; Injection drug use.

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Conflict of interest statement

The authors have no financial or other conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
The number of admission for infective endocarditis (IE), number testing positive for HCV, and number with a positive result for opiate or heroin toxicology test from 1999–2009. HCV+, those testing positive for hepatitis C virus antibody; IE, infected endocarditis; Tox+, those with positive result for opiate or heroin toxicology tests.
FIGURE 2
FIGURE 2
Hamilton County Coroner’s Crime Laboratory Heroin Submissions 2001–2010.
See this image and copyright information in PMC

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