Serious heart infections caused by injection drug use are on the rise, particularly among young whites, according to a new study published in Open Forum Infectious Diseases, now available online. Based on an analysis of health care claims data, the study found an increasing proportion of injection drug users hospitalized with infective endocarditis who were younger than 34 years old, white, and female, suggesting demographic shifts that mirror similar trends seen in the nationwide opioid epidemic.
"These infections are dangerous and often need surgery, and people who inject drugs frequently get these infections," said Alysse G. Wurcel, MD, MS, of Tufts Medical Center and Tufts University School of Medicine in Boston. "We're seeing across the country that injection drug use is not necessarily an urban or an impoverished community issue. The racial, age, and gender distributions are changing."
Treatment for infective endocarditis, which can be fatal, usually involves several weeks of intravenous antibiotics and sometimes surgery to repair or replace damaged heart valves. In the study, researchers used a publicly available database of inpatient discharges from community hospitals across the country, which are weighted to produce national estimates. Between 2000 and 2013, the study authors found an overall increase, from 7 percent to 12 percent, in the proportion of patients hospitalized for infective endocarditis whose infections were the result of injection drug use, based on diagnostic codes.
The researchers also detected significant demographic shifts: The proportion of hospitalizations for heart infections tied to drug use among patients between the ages of 15 and 34 steadily increased, from 27 percent to 42 percent, from 2000 to 2013. The proportion of such hospitalizations among whites increased from 40 percent to 69 percent. Although female patients were less common, overall, among those hospitalized with infective endocarditis linked to drug use, females accounted for 53 percent of such patients in the younger 15-34 age group.
"We think the findings are a signal that we need more programs in place trying to help prevent these types of infections from happening, because they are so deadly and costly to the health care system," said Dr. Wurcel, who noted that there is also a great need for a better understanding of how to coordinate the often prolonged care of patients with these infections, and a better understanding of how and when to educate young people about the risks of opioid abuse and injection drug use.
Future studies analyzing the costs of treating infective endocarditis among patients who inject drugs are also needed, the study authors said, and may help spur support and increased funding for additional harm-reduction efforts, including needle-exchange programs, which allow injection drug users to obtain clean needles and syringes.
- Infective endocarditis is a serious infection of the heart usually treated with several weeks of intravenous antibiotics and sometimes surgery.
- Using health care claims data from 2000 to 2013, this study found an increasing number of patients hospitalized with infective endocarditis tied to injection drug use. A growing proportion of these patients were younger than 34 years old, white, and female.
- The study's findings suggest a growing need for programs and services to prevent these infections, which can be deadly and are costly to treat, and to address the nationwide opioid epidemic.