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Endocarditis in the setting of IDU: multidisciplinary management

Yanagawa, Bobbya; Bahji, Aneesb; Lamba, Wiplovec; Tan, Darrell, H.d; Cheema, Asime; Syed, Ishbae; Verma, Subodha

Current Opinion in Cardiology: March 2018 - Volume 33 - Issue 2 - p 140–147
doi: 10.1097/HCO.0000000000000493
VALVULAR HEART DISEASE: Edited by Bobby Yanagawa and Subodh Verma

Purpose of review The purpose of this article is to provide a brief overview of the medical and surgical management of infective endocarditis secondary to IDU, with a focus on the underlying substance use disorder.

Recent findings Patients with infective endocarditis secondary to IDU are often young with unique comorbidities including mental illness, chronic hepatitis C, HIV infection, which are often compounded by limited social and familial supports. The focus of management has been treatment of endocarditis using IV antibiotics alongside surgery. Surgical outcomes compare favorably with those of infective endocarditis in the general population but long-term outcomes of IDUs are significantly worse. This is primarily due to the high rate of recidivism of drug use and the risk of prosthetic valve infective endocarditis. Contemporary management of addiction utilizes an integrative approach, combining both pharmacologic and nonpharmacologic strategies while remaining patient-centered. Given the complexity of care required, we advocate for a multidisciplinary team-based approach including psychiatry, infectious disease, cardiology, cardiac surgery and social services.

Summary Infective endocarditis secondary to IDU remains a medical and surgical challenge with dismal outcomes. Here we offer practical suggestions on the multidisciplinary management of this challenging and high-risk patient cohort.

aDivision of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto

bDepartment of Psychiatry, Queen's University, Kingston

cDivision of Psychiatry

dDivision of Infectious Disease

eDivision of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada

Correspondence to Bobby Yanagawa, MD, PhD, FRCSC, Assistant Professor, Division of Cardiac Surgery, Department of Surgery, St. Michael's Hospital, University of Toronto, 30 Bond Street, 8th Floor, Bond Wing, Toronto, ON, Canada M5B 1W8. Tel: +1 416 864 5706; fax: +1 416 864 5031; e-mail:

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