Infective Endocarditis in Individuals with Drug Addiction: A Retrospective Cohort Study Conducted at "Dr. Carol Davila" Central Military Emergency University Hospital in Bucharest

Abstract: Objective: Evaluation of individuals with intravenous drug addiction who developed infective endocarditis (IE) is required for a better understanding of the management that can be applied in these cases. This study aimed to shed light on the complex interplay between intravenous drug use and IE with the ultimate goal of improving patient care and outcomes Method: The study examined the clinical outcomes of 43 patients admitted with infective endocarditis (IE) associated with injection drug use. Data was collected over an average follow-up period of 12 months, providing a substantial timeframe to assess the long-term effects of different treatment approaches. The research focused on comparing the outcomes between two distinct groups: patients who received medical treatment alone and those who underwent surgical intervention in addition to medical management. Results This study included 43 intravenous drug users who were diagnosed with infective endocarditis (IE). The mean age of the patient cohort was 31 ± 9 years with a predominance of males (74.4%). All cases involved native valve IE, with the aortic valve being the most commonly affected (62.9%), followed by the tricuspid (30.2%) and mitral valves (6.9 %). Multiple valve involvement was observed in 13.9% of the cases. The study population had a high prevalence of comorbidities, particularly HIV infection (65.1%) and hepatitis C infection (25.5%). The study also revealed that 19.3% of the patients had previously experienced IE. Mortality rates were slightly higher in patients with recurrent IE (23.2%) than in those who experienced their first episode. Transthoracic echocardiography proved to be a highly effective diagnostic tool for detecting vegetation in 95% of the cases. Microbiological analysis identified Staphylococcus aureus as the predominant causative organism, isolated from blood cultures in 55.8% of the cases. These findings highlight the complex nature of IE in intravenous drug users, emphasizing the importance of comprehensive management strategies that address both cardiac manifestations and underlying comorbidities in this high-risk population. Conclusions: Injection drug use–associated infective endocarditis presents a significant challenge in modern healthcare, with patients facing a high risk of complications and poor clinical outcomes despite current therapeutic approaches. This persistent issue underscores the complexity of treating individuals with both infectious diseases and substance use disorders. The multifaceted nature of these cases often involves immediate cardiac infection, as well as concurrent medical, psychological, and social challenges that can complicate treatment and recovery.