Cor Vasa 2004, 45(6):274-280

Infectious endocarditis in intravenous drug addicts. Patients hospitalized at the Department of Infectious Disease of Na Bulovce Hospital over the 1981-2002 period

Maria Kabelková^1,*, Jiří Beneš¹, Miroslav Helcl¹, Jana Příhodová¹, Rudolf Feuereisl², Jan Zeman³

¹ Infekční klinika

² Kardiologie Na Bulovce, s. r. o.

³ Oddělení funkční diagnostiky, Fakultní nemocnice Na Bulovce a 3. lékařská fakulta Univerzity Karlovy, Praha, Česká republika

Aim of study:
To point to infectious endocarditis (IE) as a complication of intravenous drug addiction, its incidence, course, and complications in this country.

Method:
A retrospective study of IE cases in intravenous (i. v.) drug addicts hospitalized at the Department of Infectious Disease of Na Bulovce University Hospital in the years 1981-2002. The fate of surviving patients was traced retrospectively for a period of one year from cure.

Results:
Our group includes 29 cases of IE in 26 i. v. drug addicts (3 cases of recurrence in two patients). Tricuspid valve was involved in 21 cases (72%), left heart valves in six (21%), bilateral valve involvement was noted in two cases (7%). In addition to i. v. drug addiction, two patients were shown to have a two-cusp aortic valve as a predisposing factor. As regards the etiology, the predominant agent was Staphylococcus aureus, identified in 22 cases (76%), with yet another pathogen isolated from blood cultures. Only in two cases was another agent identified. The etiology remained unidentified in five cases (17%). All cases of right-heart IE included pulmonary embolism. Serious complications with a high case fatality were the acute respiratory distress syndrome (ARDS) (5 cases, 60% mortality) and the multiorgan dysfunction syndrome (MODS) (3 cases, 66% mortality). A total of 21 patients (72%) were cured in our center while three with tricuspid IE were transferred to a department of cardiology to be considered for surgery. Five patients (17%) died; of this number, three had isolated tricuspid valve endocarditis. As a result, the death rate of tricuspid endocarditis totaled 19%. Recurrence of symptoms was seen in four patients. Only in one patient were we unable to trace back data on his health status covering a one-year period from his cure.

Conclusion:
IE is a relatively rare infectious complication of i. v. drug addiction in this country. However, mention should be made of the relatively high case fatality (19%) of tricuspid IE, regarded as a disease with a relatively good prognosis. The cause is twofold: (1) the diagnosis is established late and the drug addict is late in seeking medical attention. Prognosis could also be improved by scheduling in time the patient with conservatively uncontrollable infection for surgery.

Keywords: Infectious endocarditis; Intravenous drug addiction; Acute respiratory distress syndrome (ARDS); Multiorgan dysfunction syndrome (MODS)

Published: June 1, 2004  Show citation