{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T11:05:40Z","timestamp":1779275140094,"version":"3.51.4"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T00:00:00Z","timestamp":1777680000000},"content-version":"vor","delay-in-days":4,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"Hospital Cl\u00ednico de Barcelona"},{"DOI":"10.13039\/501100015756","name":"Spanish Society of Infectious Diseases and Clinical Microbiology","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100015756","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Biomedical Research Network Center of Infectious Diseases"},{"DOI":"10.13039\/501100022335","name":"Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100022335","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Knowing the prevalence of patent foramen ovale (PFO) and the increasing number of people who inject drugs (PWID) with right-sided infective endocarditis (RSIE), we aimed to better characterize the syndrome of injection drug use, RSIE, and PFO with systemic embolic events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>A systematic search across multiple databases was independently screened using predefined criteria (from inception until September 2025). Published cases of adult PWID diagnosed with RSIE and ischemic stroke or other systemic embolic event were included, provided they had PFO assessment. Individuals were excluded if they had cardiac implantable electronic device (CIED) infections or any other conditions associated with systemic or paradoxical embolism.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The review identified 13 studies with 14 young patients, mostly without comorbidities, predominantly infected with Staphylococcus aureus. In most cases, echocardiography revealed large tricuspid valve vegetations. Neuroimaging confirmed multiple ischemic infarcts, while 5 patients showed emboli outside the central nervous system (4 of them as the only systemic embolism). At least 11 (79%) patients had echocardiographic evidence of right-to-left shunting. Management included cardiac surgery in 6 cases that involved valve replacement or repair, percutaneous PFO closure in 2 cases, and percutaneous mechanical aspiration in 1 case. Three patients (21%) died during hospitalization, and only 27.3% patients had outpatient follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>RSIE with systemic embolism in PWID with PFO has rarely been reported, affects younger patients without sex predominance, and was usually due to S. aureus with large tricuspid vegetations. Right-to-left shunting was characteristic, and outcomes were poor despite combined medical, surgical, and interventional therapies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ofid\/ofag245","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T11:44:49Z","timestamp":1777031089000},"source":"Crossref","is-referenced-by-count":0,"title":["Systemic Embolic Events in People Who Inject Drugs With Patent Foramen Ovale and Right-Sided Infective Endocarditis: A Systematic Review"],"prefix":"10.1093","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7075-943X","authenticated-orcid":false,"given":"Guillermo","family":"Cuervo","sequence":"first","affiliation":[{"name":"Infectious Diseases Department, Hospital Clinic-IDIBAPS, University of Barcelona , Barcelona ,","place":["Spain"]},{"name":"CIBERINFEC, Instituto de Salud Carlos III , Madrid ,","place":["Spain"]},{"name":"Department of Medicine, Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic , Rochester, Minnesota ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3507-6411","authenticated-orcid":false,"given":"Supavit","family":"Chesdachai","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic , Rochester, Minnesota ,","place":["USA"]},{"name":"Department of Cardiovascular Medicine, Mayo Clinic , Rochester, Minnesota ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1522-3915","authenticated-orcid":false,"given":"Danielle","family":"Gerberi","sequence":"additional","affiliation":[{"name":"Department of Library Services, Mayo Clinic , Rochester, Minnesota ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher V","family":"DeSimone","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic , Rochester, Minnesota ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9560-1102","authenticated-orcid":false,"given":"Abhishek J","family":"Deshmukh","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic , Rochester, Minnesota ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8057-7755","authenticated-orcid":false,"given":"Jos\u00e9 M","family":"Mir\u00f3","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department, Hospital Clinic-IDIBAPS, University of Barcelona , Barcelona ,","place":["Spain"]},{"name":"CIBERINFEC, Instituto de Salud Carlos III , Madrid ,","place":["Spain"]},{"name":"Reial Academia de Medicina de Catalunya , Barcelona ,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdallah","family":"El Sabbagh","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic , Jacksonville, Florida ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9441-0283","authenticated-orcid":false,"given":"Daniel C","family":"DeSimone","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic , Rochester, Minnesota ,","place":["USA"]},{"name":"Department of Cardiovascular Medicine, Mayo Clinic , Rochester, Minnesota ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4473-7077","authenticated-orcid":false,"given":"Larry M","family":"Baddour","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic , Rochester, Minnesota ,","place":["USA"]},{"name":"Department of Cardiovascular Medicine, Mayo Clinic , Rochester, Minnesota ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,5,2]]},"reference":[{"key":"2026052006113914300_ofag245-B1","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.1111\/ajt.13776","article-title":"Increases in drug and opioid overdose deaths\u2014United States, 2000\u20132014","volume":"16","author":"Rudd","year":"2016","journal-title":"Am J Transplant"},{"key":"2026052006113914300_ofag245-B2","first-page":"100557","article-title":"Opioid crisis: addiction, overprescription, and insufficient primary prevention","volume":"23","author":"The Lancet Regional Health\u2014Americas","year":"2023","journal-title":"Lancet Reg Health Am"},{"key":"2026052006113914300_ofag245-B3","doi-asserted-by":"crossref","first-page":"E187","DOI":"10.1161\/CIR.0000000000001090","article-title":"Management of infective endocarditis in people who inject drugs: a scientific statement from the American Heart Association","volume":"146","author":"Baddour","year":"2022","journal-title":"Circulation"},{"key":"2026052006113914300_ofag245-B4","doi-asserted-by":"crossref","first-page":"1185","DOI":"10.1016\/j.athoracsur.2020.03.089","article-title":"The evolving burden of drug use associated infective endocarditis in the United States","volume":"110","author":"Geirsson","year":"2020","journal-title":"Ann Thorac Surg"},{"key":"2026052006113914300_ofag245-B5","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1016\/j.jacc.2020.11.062","article-title":"Prospective cohort study of infective endocarditis in people who inject drugs","volume":"77","author":"Peric\u00e0s","year":"2021","journal-title":"J Am Coll Cardiol"},{"key":"2026052006113914300_ofag245-B6","doi-asserted-by":"crossref","first-page":"1463","DOI":"10.1001\/jama.2025.10946","article-title":"Patent foramen ovale and stroke: a review","volume":"334","author":"Kent","year":"2025","journal-title":"JAMA"},{"key":"2026052006113914300_ofag245-B7","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1001\/archinte.164.9.950","article-title":"Patent foramen ovale in cryptogenic stroke: current understanding and management options","volume":"164","author":"Wu","year":"2004","journal-title":"Arch Intern Med"},{"key":"2026052006113914300_ofag245-B8","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1177\/19418744231159460","article-title":"Strokes in patients with injection drug use and tricuspid valve endocarditis\u2014a case series","volume":"13","author":"Hingorani","year":"2023","journal-title":"Neurohospitalist"},{"key":"2026052006113914300_ofag245-B9","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1086\/313753","article-title":"Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis","volume":"30","author":"Li","year":"2000","journal-title":"Clin Infect Dis"},{"key":"2026052006113914300_ofag245-B10","first-page":"S516 EP-S517","article-title":"Impending paradoxical embolus in a patient with endocarditis and PFO","volume":"32","author":"Bahrami","year":"2017","journal-title":"J Gen Intern Med"},{"key":"2026052006113914300_ofag245-B11","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2019-233477","article-title":"Systemic septic emboli in tricuspid endocarditis due to an atrial communication with a right-to-left shunt","volume":"13","author":"Farrant","year":"2020","journal-title":"BMJ Case Rep"},{"key":"2026052006113914300_ofag245-B12","doi-asserted-by":"crossref","first-page":"3026","DOI":"10.1016\/S0735-1097(23)03470-8","article-title":"Double-trouble: a case of tricuspid valve endocarditis and systemic embolization","volume":"81","author":"Fernandes","year":"2023","journal-title":"J Am Coll Cardiol"},{"key":"2026052006113914300_ofag245-B13","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1007\/s12574-018-0371-y","article-title":"A rare case of paradoxical embolism from tricuspid valve infective endocarditis and patent foramen ovale","volume":"16","author":"Fong","year":"2018","journal-title":"J Echocardiogr"},{"key":"2026052006113914300_ofag245-B14","doi-asserted-by":"crossref","first-page":"i784","DOI":"10.1093\/ehjci\/jez319.743","article-title":"Right sided infective endocarditis with paradoxical embolization","volume":"21","author":"Hammad","year":"2020","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2026052006113914300_ofag245-B15","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2021-243370","article-title":"Patient with systemic emboli in the setting of Klebsiella oxytoca tricuspid valve endocarditis and patent foramen ovale treated with NobleStitch and AngioVac","volume":"14","author":"Leso","year":"2021","journal-title":"BMJ Case Rep"},{"key":"2026052006113914300_ofag245-B16","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1093\/qjmed\/hcy187","article-title":"Right sided infective endocarditis and systemic emboli","volume":"112","author":"Patti","year":"2019","journal-title":"QJM"},{"key":"2026052006113914300_ofag245-B17","article-title":"Tricuspid endocarditis leading to a stroke: a case report of paradoxical embolism in a young intravenous drug user","volume":"17","author":"Quasem","year":"2025","journal-title":"Cureus"},{"key":"2026052006113914300_ofag245-B18","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2022-250272","article-title":"Paradoxical embolisation in right-sided infective endocarditis and patent foramen ovale","volume":"15","author":"Shimfessel","year":"2022","journal-title":"BMJ Case Rep"},{"key":"2026052006113914300_ofag245-B19","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2022-254403","article-title":"Paradoxical embolisation to the brain in right-sided infective endocarditis and patent foramen ovale in a pregnant woman","volume":"16","author":"Tackett","year":"2023","journal-title":"BMJ Case Rep"},{"key":"2026052006113914300_ofag245-B20","doi-asserted-by":"crossref","first-page":"A394 EP-A395","DOI":"10.1016\/j.chest.2024.06.289","article-title":"Paradoxical systemic embolism in the context of right-sided infective endocarditis and a patent foramen ovale","volume":"166","author":"Siddique","year":"2024","journal-title":"Chest"},{"key":"2026052006113914300_ofag245-B21","doi-asserted-by":"crossref","first-page":"3710","DOI":"10.1016\/S0735-1097(23)04154-2","article-title":"RIGHT sided infective endocarditis leading to systemic septic emboli in the setting of patent foramen ovale","volume":"81","author":"Waqar","year":"2023","journal-title":"J Am Coll Cardiol"},{"key":"2026052006113914300_ofag245-B22","author":"JBI Critical Appraisal Tools | JBI"},{"key":"2026052006113914300_ofag245-B23","doi-asserted-by":"crossref","first-page":"560","DOI":"10.7326\/0003-4819-117-7-560","article-title":"Right-sided endocarditis in intravenous drug users. Prognostic features in 102 episodes","volume":"117","author":"Hecht","year":"1992","journal-title":"Ann Intern Med"},{"key":"2026052006113914300_ofag245-B24","doi-asserted-by":"crossref","first-page":"36648","DOI":"10.1161\/JAHA.124.036648","article-title":"Comprehensive assessment of the risk of symptomatic embolism in patients with infective endocarditis","volume":"14","author":"Santos-Patarroyo","year":"2025","journal-title":"J Am Heart Assoc"},{"key":"2026052006113914300_ofag245-B25","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1016\/j.jacc.2025.06.054","article-title":"Outcomes of percutaneous mechanical aspiration in right-sided infective endocarditis: a multicenter registry","volume":"86","author":"El Sabbagh","year":"2025","journal-title":"J Am Coll Cardiol"},{"key":"2026052006113914300_ofag245-B26","doi-asserted-by":"crossref","first-page":"106566","DOI":"10.1016\/j.jaccas.2025.106566","article-title":"Temporary PFO closure to mitigate embolic risk during percutaneous debulking of large tricuspid valve vegetations","volume":"31","author":"Bhatti","year":"2026","journal-title":"JACC Case Rep"},{"key":"2026052006113914300_ofag245-B27","doi-asserted-by":"crossref","first-page":"1321","DOI":"10.1016\/j.cmi.2025.02.008","article-title":"Efficacy and safety of mechanical thrombectomy in acute ischaemic stroke secondary to infective endocarditis","volume":"31","author":"Lape\u00f1a","year":"2025","journal-title":"Clin Microbiol Infect"},{"key":"2026052006113914300_ofag245-B28","doi-asserted-by":"crossref","first-page":"E12","DOI":"10.1093\/cid\/ciad664","article-title":"Frame shift: focusing on harm reduction and shared decision making for people who use drugs hospitalized with infections","volume":"78","author":"Thakarar","year":"2024","journal-title":"Clin Infect Dis"}],"container-title":["Open Forum Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ofid\/advance-article-pdf\/doi\/10.1093\/ofid\/ofag245\/68202075\/ofag245.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/13\/5\/ofag245\/68202075\/ofag245.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/13\/5\/ofag245\/68202075\/ofag245.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T10:11:49Z","timestamp":1779271909000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ofid\/article\/doi\/10.1093\/ofid\/ofag245\/8666459"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,28]]},"references-count":28,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,4,28]]}},"URL":"https:\/\/doi.org\/10.1093\/ofid\/ofag245","relation":{},"ISSN":["2328-8957"],"issn-type":[{"value":"2328-8957","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,5]]},"published":{"date-parts":[[2026,4,28]]},"article-number":"ofag245"}}