Clinical characteristics and outcome of infective endocarditis among intravenous drug abusers in India

Abhishek Goyal, Bishav Mohan, Pawan Kumar, Dinesh Gupta, Rohit Tandon, Sonaal Singla, Gurbhej Singh, Bhupinder Singh, Shibba Takkar Chhabra, Naved Aslam, Gurpreet S Wander, Abhishek Goyal, Bishav Mohan, Pawan Kumar, Dinesh Gupta, Rohit Tandon, Sonaal Singla, Gurbhej Singh, Bhupinder Singh, Shibba Takkar Chhabra, Naved Aslam, Gurpreet S Wander

Abstract

Introduction: Infective endocarditis (IE) is the most dreaded complication of intravenous drug abuse (IVDA). IVDA is present in significant proportions in India. Since there is scarcity of Indian data on IVDA associated IE, we report a study comparing IVDA to non IVDA associated IE. We compare differences in clinical profile, microbiology, echocardiography and clinical outcome from a tertiary care hospital.

Methods: A total of 133 patients admitted from 1st January 2017 to 31st December 2019 who met the Modified Duke ''definitive'' criteria for IE were included. Detailed Information was collected regarding demography, clinical data and laboratory investigations. All patients underwent transthoracic echocardiography and trans-esophageal echocardiogram wherever necessary.

Results: Among a total of 133 patients, 54 patients (40.6%) were iv drug abusers. Patients in IVDA-group were younger, mostly males, more likely to have concomitant HCV and HIV infections compared to non IVDA-group. Chronic comorbidities such as DM and CKD were more common in non IVDA-group. Rate of positive blood culture was higher in IVDA-group compared to non IVDA-group (74.1%v/s 32.9%,p < 0.001) with different microbiological profile. Percentage of Methicillin resistant staphylococcus aureus (42.6%v/s17.7%,p = 0.003) and pseudomonas related IE (18.5%v/s2.5%,p = 0.003) was significantly higher among IVDA-group. IVDA-group most commonly had tricuspid valve involvement Whereas mitral and aortic valve were most commonly involved valve in non IVDA-group. Mortality was slightly higher among IVDA-group compared to non IVDA-group, though statistically non-significant. Left sided valve involvement and Congestive heart failure were independent predictors of mortality.

Conclusion: IVDA-IE is a significant problem in India. Demographic, microbiological and echocardiographic profile is quite different in IVDA and non IVDA-group. There is urgent need to conduct larger studies.

Keywords: Echocardiography; India; Infective endocarditis; Intra venous drug abuse; Microbiological characteristics.

Conflict of interest statement

Conflicts of interest All authors have none to declare.

Copyright © 2020. Published by Elsevier B.V.

References

    1. Math R.S., Sharma G., Kothari S.S. Prospective study of infective endocarditis from a developing country. Am Heart J. 2011;162(4):633–638.
    1. Kim J.B., Ejiofor J.I., Yammine M. Surgical outcomes of infective endocarditis among intravenous drug users. J Thorac Cardiovasc Surg. 2016;152(3):832–841. e1.
    1. Kadri A.N., Wilner B., Hernandez A.V. Geographic trends, patient characteristics, and outcomes of infective endocarditis associated with drug abuse in the United States from 2002 to 2016. J Am Heart Assoc. 2019;8(19)
    1. Grover A., Anand I.S., Varma J. Profile of right-sided endocarditis: an Indian experience. Int J Cardiol. 1991;33(1):83–88.
    1. Raut N., Potdar A., Sharma S. Tricuspid valve endocarditis in non-drug abusers: a case series from India. Indian Heart J. 2018;70(4):476–481.
    1. Ambekar A., Agrawal A., Rao R. Ministry of Social Justice and Empowerment, Government of India; New Delhi: 2019. On Behalf of the Group of Investigators for the National Survey on Extent and Pattern of Substance Use in India. Magnitude of Substance Use in India. [cited 2020 june 20]. Available from:
    1. Punjab Opioid Dependence Survey (PODS),estimation of the size of opioid dependent population in Punjab, Brief Report. [cited 2020 September 25]. Available from: .
    1. Li J.S., Sexton D.J., Mick N. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis. 2000;30(4):633–638.
    1. Fernandes E., Olive C., Inamo J. Infective endocarditis in French west indies: a 13-year observational study. Am J Trop Med Hyg. 2017;97(1):77–83.
    1. Murdoch D.R., Corey G.R., Hoen B. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study. Arch Intern Med. 2009;169(5):463–473.
    1. Senthilkumar S., Menon T., Subramanian G. Epidemiology of infective endocarditis in Chennai, South India. Indian J Med Sci. 2010;64(4):187–191.
    1. Gupta A., Gupta A., Kaul U. Infective endocarditis in an Indian setup: are we entering the 'modern' era? Indian J Crit Care Med. 2013;17(3):140–147.
    1. Choudhury R., Grover A., Varma J. Active infective endocarditis observed in an Indian hospital 1981-1991. Am J Cardiol. 1992;70:1453–1458.
    1. Garg N., Kandpal B., Garg N. Characteristics of infective endocarditis in a developing country: clinical profile and outcome in 192 Indian patients, 1992-2001. Int J Cardiol. 2005;98:253–260.
    1. Leahey P.A., LaSalvia M.T., Rosenthal E.S. High morbidity and mortality among patients with sentinel admission for injection drug use-related infective endocarditis. Open Forum Infect Dis. 2019;6(4):ofz089.
    1. Negi P.C., Sondhi S., Asotra S. Current status of rheumatic heart disease in India. Indian Heart J. 2019;71(1):85–90.
    1. Karthikeyan G. Rheumatic heart disease in India: declining, but not fast enough. Natl Med J India. 2017;30(5):247–248.
    1. Ramakrishnan S., Kothari S.S., Bahl V.K. Prevalence of rheumatic heart disease: has it declined in India? Natl Med J India. 2009;22(2):72–74.
    1. Subbaraju P., Rai S., Morakhia J. Clinical - microbiological characterization and risk factors of mortality in infective endocarditis from a tertiary care academic hospital in Southern India. Indian Heart J. 2018;70(2):259–265.
    1. Ghosh S., Sahoo R., Nath R.K. A study of clinical, microbiological, and echocardiographic profile of patients of infective endocarditis. IntSch Res Notices. 2014;2014:340601.
    1. Padmaja K., Sudhaharan S., Vemu L. Clinicomicrobiological spectrum of infective endocarditis - from a tertiary care centre in south India. Iran J Microbiol. 2017;9(5):257–263.
    1. Slipczuk L., Codolosa J.N., Davila C.D. Infective endocarditis epidemiology over five decades: a systematic review [published correction appears in PLoS One. PloS One. 2014;9(10) 2013;8(12):e82665.
    1. Miró J.M., Moreno A., Mestres C.A. Infective endocarditis in intravenous drug abusers. Curr Infect Dis Rep. 2003;5(4):307–316.
    1. Muñoz P., Kestler M., De Alarcon A. Current epidemiology and outcome of infective endocarditis: a multicenter, prospective, cohort study. Medicine (Baltim) 2015;94(43)
    1. Rudasill S.E., Sanaiha Y., Mardock A.L. Clinical outcomes of infective endocarditis in injection drug users. J Am Coll Cardiol. 2019;73(5):559–570.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe