Endocarditis as a Marker for New Epidemics of Injection Drug Use
Endocarditis as a Marker for New Epidemics of Injection Drug Use
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DOI：
10.1016/j.amjms.2016.10.002
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发表时间：
2016-12-01
影响因子：
3.1
通讯作者：
Feinberg, Judith
中科院分区：
文献类型：
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作者：
Keeshin, Susana Williams;Feinberg, Judith
背景：我们对一家学术教学医院的感染性心内膜炎 (IE) 出院情况进行了 10 多年的调查，以评估 IE 住院人数的增加和 IE 患者丙型肝炎病毒 (HCV) 的增加是否可以预测新的注射毒品使用 (IDU) 流行。材料和方法：根据修订的杜克标准对诊断为 IE 的出院患者进行回顾性医疗记录审查。采用Student's t检验、卡方检验和Fisher精确检验计算P值。结果：392例独特的IE患者中有542例出院，104例患者再次入院2-7次。在总出院人数中，367 人 (67.7%) 未进行 HCV 筛查，在接受检测的人中，86 人 (49.1%) 为 HCV+； 404 人 (74.5%) 未接受 HIV 筛查，在接受检测的人中，28 人 (20.3%) 为 HIV +。与那些自我报告没有注射吸毒者的患者相比，自我认定为注射吸毒者的患者更有可能接受 HCV 检测，分别为 75 例（69.4%）和 12 例（31.5%，P < 0.0001），以及 HIV 检测，分别为 72 例（66.6%）和 13 例（34.2%，P < 0.0001）。与毒理学测试结果阴性的人相比，阿片或海洛因毒理学测试结果呈阳性的人更有可能接受 HCV 筛查（分别为 70 人（66%）与 22 人（44.8%，P < 0.0001），以及 HIV 筛查，分别为 66 人（62.2%）与 25 人（51%，P < 0.0001）。在此期间，IE 病例增加了 2 倍，HCV 抗体流行率增加了 3 倍，阿片毒理学筛查显示阳性结果增加了 6 倍，但 HIV 没有增加。 结论：虽然 IDU 是 IE 的已知危险因素，但观察到 IE 病例急剧增加可能预示着 IDU 和 HCV 的新流行。
Background: We examined discharges for infective endocarditis (IE) at an academic teaching hospital for over 10 years to evaluate if an increase in hospitalizations for IE and increase in hepatitis C virus (HCV) in patients with IE could predict a new epidemic of injection drug use (IDU).Materials and Methods: Retrospective medical record review of discharged patients with the diagnosis of IE as defined by the modified Duke criteria. Student's t test, chi-squared test and Fisher's exact test were used to calculate P values.Results: There were 542 discharges among 392 unique patients with IE and 104 patients were readmitted 2-7 times. Of the total discharges, 367 (67.7%) were not screened for HCV, and of those tested, 86 (49.1%) were HCV+; 404 (74.5%) were not screened for HIV and of those tested, 28 (20.3%) were HIV+. Patients who self-identify as a person who injects drugs were more likely to be tested for HCV, 75 (69.4%) versus 12 (31.5%, P < 0.0001), and for HIV, 72 (66.6%) versus 13 (34.2%, P < 0.0001) compared with those who self-report no IDU. Those with a positive result for opiate or heroin toxicology test were more likely to be screened for HCV, 70 (66%) versus 22 (44.8%, P < 0.0001), and for HIV, 66 (62.2%) versus 25 (51%, P < 0.0001) than those with negative result for toxicology test. Over this period, there was a 2-fold increase in IE cases, a 3-fold increase in HCV antibody prevalence and a 6-fold increase in opiate toxicology screens showing positive result, but no increase in HIV.Conclusions: Although IDU is a known risk factor for IE, the observation of a sharp increase in IE cases may signal a new epidemic of IDU and HCV.