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Steep rise in drug use-associated infective endocarditis in West Virginia: Characteristics and healthcare utilization
INTRODUCTION: Life-threatening infections such as infective endocarditis (IE) are increasing simultaneously with the injection drug use epidemic in West Virginia (WV). We utilized a newly developed, statewide database to describe epidemiologic characteristics and healthcare utilization among patient...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9286279/ https://www.ncbi.nlm.nih.gov/pubmed/35839224 http://dx.doi.org/10.1371/journal.pone.0271510 |
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author | Bhandari, Ruchi Alexander, Talia Annie, Frank H. Kaleem, Umar Irfan, Affan Balla, Sudarshan Wiener, R. Constance Cook, Chris Nanjundappa, Aravinda Bates, Mark Thompson, Ellen Smith, Gordon S. Feinberg, Judith Fisher, Melanie A. |
author_facet | Bhandari, Ruchi Alexander, Talia Annie, Frank H. Kaleem, Umar Irfan, Affan Balla, Sudarshan Wiener, R. Constance Cook, Chris Nanjundappa, Aravinda Bates, Mark Thompson, Ellen Smith, Gordon S. Feinberg, Judith Fisher, Melanie A. |
author_sort | Bhandari, Ruchi |
collection | PubMed |
description | INTRODUCTION: Life-threatening infections such as infective endocarditis (IE) are increasing simultaneously with the injection drug use epidemic in West Virginia (WV). We utilized a newly developed, statewide database to describe epidemiologic characteristics and healthcare utilization among patients with (DU-IE) and without (non-DU-IE) drug use-associated IE in WV over five years. MATERIALS AND METHODS: This retrospective, observational study, incorporating manual review of electronic medical records, included all patients aged 18–90 years who had their first admission for IE in any of the four university-affiliated referral hospitals in WV during 2014–2018. IE was identified using ICD-10-CM codes and confirmed by chart review. Demographics, clinical characteristics, and healthcare utilization were compared between patients with DU-IE and non-DU-IE using Chi-square/Fisher’s exact test or Wilcoxon rank sum test. Multivariable logistic regression analysis was conducted with discharge against medical advice/in-hospital mortality vs. discharge alive as the outcome variable and drug use as the predictor variable. RESULTS: Overall 780 unique patients had confirmed first IE admission, with a six-fold increase during study period (p = .004). Most patients (70.9%) had used drugs before hospital admission, primarily by injection. Compared to patients with non-DU-IE, patients with DU-IE were significantly younger (median age: 33.9 vs. 64.1 years; p < .001); were hospitalized longer (median: 25.5 vs. 15 days; p < .001); had a higher proportion of methicillin-resistant Staphylococcus aureus (MRSA) isolates (42.7% vs. 29.9%; p < .001), psychiatric disorders (51.2% vs. 17.3%; p < .001), cardiac surgeries (42.9% vs. 26.6%; p < .001), and discharges against medical advice (19.9% vs. 1.4%; p < .001). Multivariable regression analysis showed drug use was an independent predictor of the combined outcome of discharge against medical advice/in-hospital mortality (OR: 2.99; 95% CI: 1.67–5.64). DISCUSSION AND CONCLUSION: This multisite study reveals a 681% increase in IE admissions in WV over five years primarily attributable to injection drug use, underscoring the urgent need for both prevention efforts and specialized strategies to improve outcomes. |
format | Online Article Text |
id | pubmed-9286279 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-92862792022-07-16 Steep rise in drug use-associated infective endocarditis in West Virginia: Characteristics and healthcare utilization Bhandari, Ruchi Alexander, Talia Annie, Frank H. Kaleem, Umar Irfan, Affan Balla, Sudarshan Wiener, R. Constance Cook, Chris Nanjundappa, Aravinda Bates, Mark Thompson, Ellen Smith, Gordon S. Feinberg, Judith Fisher, Melanie A. PLoS One Research Article INTRODUCTION: Life-threatening infections such as infective endocarditis (IE) are increasing simultaneously with the injection drug use epidemic in West Virginia (WV). We utilized a newly developed, statewide database to describe epidemiologic characteristics and healthcare utilization among patients with (DU-IE) and without (non-DU-IE) drug use-associated IE in WV over five years. MATERIALS AND METHODS: This retrospective, observational study, incorporating manual review of electronic medical records, included all patients aged 18–90 years who had their first admission for IE in any of the four university-affiliated referral hospitals in WV during 2014–2018. IE was identified using ICD-10-CM codes and confirmed by chart review. Demographics, clinical characteristics, and healthcare utilization were compared between patients with DU-IE and non-DU-IE using Chi-square/Fisher’s exact test or Wilcoxon rank sum test. Multivariable logistic regression analysis was conducted with discharge against medical advice/in-hospital mortality vs. discharge alive as the outcome variable and drug use as the predictor variable. RESULTS: Overall 780 unique patients had confirmed first IE admission, with a six-fold increase during study period (p = .004). Most patients (70.9%) had used drugs before hospital admission, primarily by injection. Compared to patients with non-DU-IE, patients with DU-IE were significantly younger (median age: 33.9 vs. 64.1 years; p < .001); were hospitalized longer (median: 25.5 vs. 15 days; p < .001); had a higher proportion of methicillin-resistant Staphylococcus aureus (MRSA) isolates (42.7% vs. 29.9%; p < .001), psychiatric disorders (51.2% vs. 17.3%; p < .001), cardiac surgeries (42.9% vs. 26.6%; p < .001), and discharges against medical advice (19.9% vs. 1.4%; p < .001). Multivariable regression analysis showed drug use was an independent predictor of the combined outcome of discharge against medical advice/in-hospital mortality (OR: 2.99; 95% CI: 1.67–5.64). DISCUSSION AND CONCLUSION: This multisite study reveals a 681% increase in IE admissions in WV over five years primarily attributable to injection drug use, underscoring the urgent need for both prevention efforts and specialized strategies to improve outcomes. Public Library of Science 2022-07-15 /pmc/articles/PMC9286279/ /pubmed/35839224 http://dx.doi.org/10.1371/journal.pone.0271510 Text en © 2022 Bhandari et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Bhandari, Ruchi Alexander, Talia Annie, Frank H. Kaleem, Umar Irfan, Affan Balla, Sudarshan Wiener, R. Constance Cook, Chris Nanjundappa, Aravinda Bates, Mark Thompson, Ellen Smith, Gordon S. Feinberg, Judith Fisher, Melanie A. Steep rise in drug use-associated infective endocarditis in West Virginia: Characteristics and healthcare utilization |
title | Steep rise in drug use-associated infective endocarditis in West Virginia: Characteristics and healthcare utilization |
title_full | Steep rise in drug use-associated infective endocarditis in West Virginia: Characteristics and healthcare utilization |
title_fullStr | Steep rise in drug use-associated infective endocarditis in West Virginia: Characteristics and healthcare utilization |
title_full_unstemmed | Steep rise in drug use-associated infective endocarditis in West Virginia: Characteristics and healthcare utilization |
title_short | Steep rise in drug use-associated infective endocarditis in West Virginia: Characteristics and healthcare utilization |
title_sort | steep rise in drug use-associated infective endocarditis in west virginia: characteristics and healthcare utilization |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9286279/ https://www.ncbi.nlm.nih.gov/pubmed/35839224 http://dx.doi.org/10.1371/journal.pone.0271510 |
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