Opiate Injection-associated Infective Endocarditis in the Southeastern United States
Opiate Injection-associated Infective Endocarditis in the Southeastern United States
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DOI：
10.1016/j.amjms.2016.08.010
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发表时间：
2016-12-01
影响因子：
3.1
通讯作者：
Files, Daniel Clark
中科院分区：
文献类型：
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作者：
Hartman, Lauren;Barnes, Erin;Files, Daniel Clark
背景：在美国，阿片类止痛药（OPR）注射滥用正在增加。感染性心内膜炎（IE）是注射OPR使用的一种毁灭性并发症，尚未得到充分研究。方法：我们对北卡罗来纳州一家学术三级护理医院的IE病例进行了回顾性图表审查。对2009-2014年的住院患者进行了明确IE病例的筛查。将报告注射药物使用（IDU）的受试者归类为IDU-IE，并与未报告IDU的受试者（归类为无IDU-IE）进行比较。结果：共127例IE事件入院，48例（37.8%）被归类为IDU-IE和79例（62.2%）为无IDU-IE。IDU-IE病例从2009年IE住院的14%增加到2014年的56%; OPR注射的报告在2012年增加，并在整个研究期间持续增加。IDU-IE受试者更年轻（32.6 +/- 11.7 vs 54.4 +/- 13.1，P < 0.0001），更可能是单身（n = 33 [68.8%]对n = 23 [29.1%]，P < 0.0001）和居住在农村社区（n = 36 [75.0%]对n = 25 [31.6%]，P < 0.0001）。住院时间（26天对12天，P < 0.0001）和重症监护室住院时间IDU-IE患者的住院时间（2天vs 1天，P = 0.04）较长，住院死亡率无差异（10. 4% IDU-IE对8.9%No IDU-IE，P = 0.77）。结论：IDU-IE率随时间增加，农村社区使用OPR注射似乎是主要原因。需要采取干预措施，减少IDU-IE和OPR滥用，以阻止风险农村社区这种日益严重的流行病。
Background: Opiate pain reliever (OPR) misuse by injection is increasing in the United States. Infective endocarditis (IE), a devastating complication of injection OPR use, has been understudied.Methods: We conducted a retrospective chart review of IE cases at an academic tertiary care hospital in North Carolina. Hospital admissions from 2009-2014 were screened for cases of definite IE. Subjects reporting injection drug use (IDU) were classified as IDU-IE, and compared to those without reported IDU, classified as No IDU-IE. Rates of IDU-IE and No IDU-IE, patient demographics, microbiologic data and outcomes were compared between the groups.Results: A total of 127 incident admissions for IE were identified, 48 (37.8%) were classified as IDU-IE and 79 (62.2%) as No IDU-IE. IDU-IE cases increased from 14% of hospitalizations for IE in 2009 to 56% in 2014; reporting of OPR injection increased in 2012 and continued through the study period. IDU-IE subjects were younger (32.6 +/- 11.7 versus 54.4 +/- 13.1, P < 0.0001), more likely to be single (n = 33 [68.8%] versus n = 23 [29.1%], P < 0.0001) and to reside in rural communities (n = 36 [75.0%] versus n = 25 [31.6%], P < 0.0001) than No IDU-IE subjects. Hospital length of stay (26 days versus 12 days, P < 0.0001) and intensive care unit length of stay (2 days versus 1 day, P = 0.04) were longer for IDU-IE patients and hospital mortality did not differ (10.4% IDU-IE versus 8.9% No IDU-IE, P = 0.77).Conclusions: IDU-IE rates increased over time, and OPR injection use in rural communities appears to be a major contributor. Interventions to reduce IDU-IE and OPR misuse are needed to halt this growing epidemic in at-risk rural communities.