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BMC Infect Dis. 2019 Nov 8;19(1):918. doi: 10.1186/s12879-019-4558-2.

Long term surgical outcomes for infective endocarditis in people who inject drugs: a systematic review and meta-analysis.

Author information

1
Division of Infectious Diseases, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave (Room 37-121CHS), Los Angeles, CA, 90095-1688, USA. dgoodman@mednet.ucla.edu.
2
Infectious Diseases, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. dgoodman@mednet.ucla.edu.
3
Department of Biostatistics, Fielding School of Public Health, UCLA, Los Angeles, CA, USA.
4
Universidad Autónoma de Baja California, Tijuana, USA.
5
Medical Imaging Informatics (MII) Group, Department of Radiological Sciences, UCLA, Los Angeles, CA, USA.
6
Division of Infectious Diseases, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave (Room 37-121CHS), Los Angeles, CA, 90095-1688, USA.
7
Infectious Diseases, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
8
Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
9
UCLA Center for Clinical AIDS Research & Education, David Geffen School of Medicine, Los Angeles, CA, USA.

Abstract

BACKGROUND:

In recent years, the number of infective endocarditis (IE) cases associated with injection drug use has increased. Clinical guidelines suggest deferring surgery for IE in people who inject drugs (PWID) due to a concern for worse outcomes in comparison to non-injectors (non-PWID). We performed a systematic review and meta-analysis of long-term outcomes in PWID who underwent cardiac surgery and compared these outcomes to non-PWID.

METHODS:

We systematically searched for studies reported between 1965 and 2018. We used an algorithm to estimate individual patient data (eIPD) from Kaplan-Meier (KM) curves and combined it with published individual patient data (IPD) to analyze long-term outcomes after cardiac surgery for IE in PWID. Our primary outcome was survival. Secondary outcomes were reoperation and mortality at 30-days, one-, five-, and 10-years. Random effects Cox regression was used for estimating survival.

RESULTS:

We included 27 studies in the systematic review and 19 provided data (KM or IPD) for the meta-analysis. PWID were younger and more likely to have S. aureus than non-PWID. Survival at 30-days, one-, five-, and 10-years was 94.3, 81.0, 62.1, and 56.6% in PWID, respectively; and 96.4, 85.0, 70.3, and 63.4% in non-PWID. PWID had 47% greater hazard of death (HR 1.47, 95% CI, 1.05-2.05) and more than twice the hazard of reoperation (HR 2.37, 95% CI, 1.25-4.50) than non-PWID.

CONCLUSION:

PWID had shorter survival that non-PWID. Implementing evidence-based interventions and testing new modalities are urgently needed to improve outcomes in PWID after cardiac surgery.

KEYWORDS:

Endocarditis; Meta-analysis; People who inject drugs; Surgery

PMID:
31699053
PMCID:
PMC6839097
DOI:
10.1186/s12879-019-4558-2
[Indexed for MEDLINE]
Free PMC Article

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