{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,8]],"date-time":"2025-06-08T04:31:04Z","timestamp":1749357064607,"version":"3.40.5"},"reference-count":18,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2022,8,26]],"date-time":"2022-08-26T00:00:00Z","timestamp":1661472000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Injection drug use (IDU) associated infective endocarditis (IE) is clinically challenging due to social issues this population endures. Rates of IDU are rising globally, however, there is a lack of clear guidelines for IDU associated IE. The aim of this study is to assess the epidemiology of the IDU and non-IDU populations and compare their long-term outcomes to help guide future management.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>An observational cohort study was conducted on all 350 patients treated for IE at St Vincent\u2019s Hospital Melbourne between 1999 and 2015. Follow up was performed until death or January 2021. Primary outcome was all-cause mortality.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>IDU patients are younger (p&lt;0.001), more likely to have concurrent infections (p&lt;0.001), and other addiction disorders (p&lt;0.001), while non-IDU patients are older with a higher level of comorbid illnesses (p&lt;0.001). IDU and non-IDU patients received similar management during their admissions and experienced similar levels of in-hospital outcomes, except for non-IDU patient being more likely to develop pneumonia post-surgery (p = 0.03). IDU patients are more likely to become reinfected (p = 0.034) but have better long-term survival, with survival estimates at 15-years being 64.98% (95%CI: 50.94\u201375.92%) for IDU patients compared to 26.67% (95%CI: 19.76\u201334.05%) for non-IDU patients (p&lt;0.001).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Despite having higher levels of reinfection, IDU patients have better long-term survival compared to non-IDU patients. Therefore, we suggest IDU patients should not have blanket restrictions on the management they are offered unless at the individual level there is a contraindication to therapy.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0270283","type":"journal-article","created":{"date-parts":[[2022,8,26]],"date-time":"2022-08-26T17:43:49Z","timestamp":1661535829000},"page":"e0270283","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Evolving mortality rates in people who inject drugs: An Australian tertiary hospital observational study on infective endocarditis"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8780-0689","authenticated-orcid":true,"given":"Isa","family":"Khan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Brookes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Santamaria","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Crisafi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Wilson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Darby","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Newcomb","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2022,8,26]]},"reference":[{"issue":"10021","key":"pone.0270283.ref001","doi-asserted-by":"crossref","first-page":"882","DOI":"10.1016\/S0140-6736(15)00067-7","article-title":"Infective endocarditis.","volume":"387","author":"TJ Cahill","year":"2016","journal-title":"Lancet"},{"issue":"15","key":"pone.0270283.ref002","doi-asserted-by":"crossref","first-page":"1890","DOI":"10.1093\/eurheartj\/ehq110","article-title":"Health care exposure and age in infective endocarditis: results of a contemporary population-based profile of 1536 patients in Australia","volume":"31","author":"RW Sy","year":"2010","journal-title":"Eur Heart J"},{"issue":"3","key":"pone.0270283.ref003","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1016\/j.jacc.2016.10.066","article-title":"Challenges in Infective Endocarditis","volume":"69","author":"TJ Cahill","year":"2017","journal-title":"J Am Coll Cardiol"},{"issue":"1","key":"pone.0270283.ref004","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.athoracsur.2011.08.016","article-title":"Long-term outcome for the surgical treatment of infective endocarditis with a focus on intravenous drug users.","volume":"93","author":"DG Rabkin","year":"2012","journal-title":"Ann Thorac Surg"},{"issue":"1","key":"pone.0270283.ref005","first-page":"125","article-title":"Infective endocarditis in intravenous drug abusers: patterns of presentation and long-term outcomes of surgical treatment","volume":"15","author":"A Carozza","year":"2006","journal-title":"J Heart Valve Dis"},{"issue":"1084","key":"pone.0270283.ref006","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1136\/postgradmedj-2015-133648","article-title":"Infective endocarditis in intravenous drug users: a review article.","volume":"92","author":"T Colville","year":"2016","journal-title":"Postgrad Med J"},{"issue":"44","key":"pone.0270283.ref007","doi-asserted-by":"crossref","first-page":"3075","DOI":"10.1093\/eurheartj\/ehv319","article-title":"2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM).","volume":"36","author":"G Habib","year":"2015","journal-title":"Eur Heart J"},{"issue":"5","key":"pone.0270283.ref008","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1093\/icvts\/ivv397","article-title":"Cardiac surgery for infective endocarditis in patients with intravenous drug use","volume":"22","author":"OB Osterdal","year":"2016","journal-title":"Interact Cardiovasc Thorac Surg"},{"issue":"5","key":"pone.0270283.ref009","doi-asserted-by":"crossref","first-page":"1486","DOI":"10.1016\/j.athoracsur.2014.02.010","article-title":"When is enough enough? The dilemma of valve replacement in a recidivist intravenous drug user.","volume":"97","author":"SC Hull","year":"2014","journal-title":"Ann Thorac Surg"},{"issue":"3","key":"pone.0270283.ref010","doi-asserted-by":"crossref","first-page":"832","DOI":"10.1016\/j.jtcvs.2016.02.072","article-title":"Surgical outcomes of infective endocarditis among intravenous drug users.","volume":"152","author":"JB Kim","year":"2016","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"4","key":"pone.0270283.ref011","doi-asserted-by":"crossref","first-page":"214","DOI":"10.5694\/j.1326-5377.2008.tb01587.x","article-title":"Trends in coronary artery bypass graft surgery in Victoria, 2001\u20132006: findings from the Australasian Society of Cardiac and Thoracic Surgeons database project.","volume":"188","author":"DT Dinh","year":"2008","journal-title":"Med J Aust."},{"issue":"4","key":"pone.0270283.ref012","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":"JS Li","year":"2000","journal-title":"Clinical Infectious Diseases"},{"issue":"2","key":"pone.0270283.ref013","doi-asserted-by":"crossref","first-page":"102","DOI":"10.2471\/BLT.12.108282","article-title":"Mortality among people who inject drugs: a systematic review and meta-analysis","volume":"91","author":"BM Mathers","year":"2013","journal-title":"Bull World Health Organ"},{"issue":"3","key":"pone.0270283.ref014","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1016\/j.athoracsur.2015.03.019","article-title":"Injection Drug Use and Outcomes After Surgical Intervention for Infective Endocarditis.","volume":"100","author":"NK Shrestha","year":"2015","journal-title":"Ann Thorac Surg"},{"issue":"1","key":"pone.0270283.ref015","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1093\/clinids\/15.1.63","article-title":"Enterococcal endocarditis.","volume":"15","author":"DW Megran","year":"1992","journal-title":"Clin Infect Dis"},{"issue":"5","key":"pone.0270283.ref016","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":"JM Pericas","year":"2021","journal-title":"J Am Coll Cardiol"},{"issue":"3","key":"pone.0270283.ref017","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1097\/ADM.0000000000000558","article-title":"Attitudes and Approaches Towards Repeat Valve Surgery in Recurrent Injection Drug Use-associated Infective Endocarditis","volume":"14","author":"M Hayden","year":"2020","journal-title":"A Qualitative Study. 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