Clinician Corner January 2015 Update
A recent study by Tung et al†
raises concerns about a local increase in the incidence of infective endocarditis among people who inject drugs.
Tung et al. examined recorded cases of endocarditis from a regional hospital in Australia between 2003-2006 and 2009-2013. They found that although the overall incidence of infective endocarditis decreased in the population, the incidence of infective endocarditis related to injecting drug use increased from 0.5 to 0.8 cases per 100,000 person years.
This trend stands in contrast to overall declines in injecting drug use and related cases of infective endocarditis both in Australia and elsewhere. It may reflect a local increase in the injection of drugs or it may reflect an increase in the risk of infective endocarditis among people who inject drugs.
Factors that can increase the risk of infective endocarditis include the injection of talc and other insoluble agents that are contained in pharmaceutical preparations, vasospasm and skin lesions that can occur with stimulant use, and the use of saliva as a drug dilatant. These risk factors may have be exacerbated by a local shift away from injecting heroin to injecting other drugs, such as pharmaceutical opioids, performance enhancing drugs and methamphetamine.
This recent local trend highlights the need to be vigilant for signs of infective endocarditis among people who inject drugs, and to continue to educate people who inject drugs about ways to reduce the risks for infective endocarditis (e.g., using filters, alcohol swabs and sterile dilatants), even in the context of overall declines in injecting drug use and related cases of infective endocarditis.
To read more visit the full paper on Early View.
Tung MKY, Light M, Giri R, Lane S, Appelbe A, Harvey C, Athan E. Evolving epidemiology of injecting drug use-associated infective endocarditis: A regional centre experience. Drug and Alcohol Review 2014