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138. Prognosis Following Valve Replacement Surgery for Infective Endocarditis Among Persons Who Inject Drugs

BACKGROUND: Infective endocarditis (IE) is a major cause of morbidity and mortality among persons who inject drugs (PWID) and rates have increased during the current opioid epidemic. Severe cases may require valve replacement surgery (VRS). These patients are typically younger with fewer comorbiditi...

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Autores principales: Bullis, Sean, Spiess, Krystine, Kemper Alston, W
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6809754/
http://dx.doi.org/10.1093/ofid/ofz360.213
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author Bullis, Sean
Spiess, Krystine
Kemper Alston, W
author_facet Bullis, Sean
Spiess, Krystine
Kemper Alston, W
author_sort Bullis, Sean
collection PubMed
description BACKGROUND: Infective endocarditis (IE) is a major cause of morbidity and mortality among persons who inject drugs (PWID) and rates have increased during the current opioid epidemic. Severe cases may require valve replacement surgery (VRS). These patients are typically younger with fewer comorbidities than those who undergo VRS for other indications. This study was designed to examine the prognosis for these cases. METHODS: The University of Vermont Medical Center is a 562-bed academic medical center. A retrospective cohort included all cases of IE among PWID who underwent VRS between November, 2009 and December, 2015. The cohort intentionally included surgeries performed prior to 2016 in order to provide sufficient follow-up time. Outcomes included survival, readmission, complications, adherence to follow-up, length of stay, rate of repeat VRS, microbiology, and recurrent bloodstream infections. RESULTS: The cohort included 31 patients. 80% were male and the median age was 31. The valves replaced or repaired included 18 aortic, 10 mitral, 9 tricuspid, and 1 pulmonic (7 patients had two valves involved). Organisms included Staphylococcus aureus (48%), Streptococcus spp. (22%), and Enterococcus (13%). The median length of stay for the index admission was 35 days. To date, at least 38% of the cohort has died. The median survival for those who died was 337 days (0–2,224). Adherence with initial outpatient follow-up visit was only 50%, with others either canceling or missing appointments. 39% followed up with infectious diseases and 39% with cardiothoracic surgery. 29% never followed up. The readmission rate was 51%, and 22% of the cohort was readmitted more than three times. 48% had a repeat bloodstream infection, 73% of which were with a different organism than the index infection. The rate of repeat VRS was 31%. CONCLUSION: Our observational data reveal a high mortality rate with poor adherence to follow-up and a high rate of readmission among this rural cohort of PWID who have VRS for IE. The major limitation of this work is the passive follow-up from the medical record. The high mortality and morbidity of this disease suggests that more intensive, multispecialty post-operative care is needed for PWID who are treated surgically. DISCLOSURES: All authors: No reported disclosures.
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spelling pubmed-68097542019-10-28 138. Prognosis Following Valve Replacement Surgery for Infective Endocarditis Among Persons Who Inject Drugs Bullis, Sean Spiess, Krystine Kemper Alston, W Open Forum Infect Dis Abstracts BACKGROUND: Infective endocarditis (IE) is a major cause of morbidity and mortality among persons who inject drugs (PWID) and rates have increased during the current opioid epidemic. Severe cases may require valve replacement surgery (VRS). These patients are typically younger with fewer comorbidities than those who undergo VRS for other indications. This study was designed to examine the prognosis for these cases. METHODS: The University of Vermont Medical Center is a 562-bed academic medical center. A retrospective cohort included all cases of IE among PWID who underwent VRS between November, 2009 and December, 2015. The cohort intentionally included surgeries performed prior to 2016 in order to provide sufficient follow-up time. Outcomes included survival, readmission, complications, adherence to follow-up, length of stay, rate of repeat VRS, microbiology, and recurrent bloodstream infections. RESULTS: The cohort included 31 patients. 80% were male and the median age was 31. The valves replaced or repaired included 18 aortic, 10 mitral, 9 tricuspid, and 1 pulmonic (7 patients had two valves involved). Organisms included Staphylococcus aureus (48%), Streptococcus spp. (22%), and Enterococcus (13%). The median length of stay for the index admission was 35 days. To date, at least 38% of the cohort has died. The median survival for those who died was 337 days (0–2,224). Adherence with initial outpatient follow-up visit was only 50%, with others either canceling or missing appointments. 39% followed up with infectious diseases and 39% with cardiothoracic surgery. 29% never followed up. The readmission rate was 51%, and 22% of the cohort was readmitted more than three times. 48% had a repeat bloodstream infection, 73% of which were with a different organism than the index infection. The rate of repeat VRS was 31%. CONCLUSION: Our observational data reveal a high mortality rate with poor adherence to follow-up and a high rate of readmission among this rural cohort of PWID who have VRS for IE. The major limitation of this work is the passive follow-up from the medical record. The high mortality and morbidity of this disease suggests that more intensive, multispecialty post-operative care is needed for PWID who are treated surgically. DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2019-10-23 /pmc/articles/PMC6809754/ http://dx.doi.org/10.1093/ofid/ofz360.213 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Bullis, Sean
Spiess, Krystine
Kemper Alston, W
138. Prognosis Following Valve Replacement Surgery for Infective Endocarditis Among Persons Who Inject Drugs
title 138. Prognosis Following Valve Replacement Surgery for Infective Endocarditis Among Persons Who Inject Drugs
title_full 138. Prognosis Following Valve Replacement Surgery for Infective Endocarditis Among Persons Who Inject Drugs
title_fullStr 138. Prognosis Following Valve Replacement Surgery for Infective Endocarditis Among Persons Who Inject Drugs
title_full_unstemmed 138. Prognosis Following Valve Replacement Surgery for Infective Endocarditis Among Persons Who Inject Drugs
title_short 138. Prognosis Following Valve Replacement Surgery for Infective Endocarditis Among Persons Who Inject Drugs
title_sort 138. prognosis following valve replacement surgery for infective endocarditis among persons who inject drugs
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6809754/
http://dx.doi.org/10.1093/ofid/ofz360.213
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