Risk factors of infective endocarditis in persons who inject drugs
Abstract Background The rising incidence of infective endocarditis (IE) among people who inject drugs (PWID) has been a major concern across North America. The coincident rise in IE and change of drug preference to hydromorphone controlled-release (CR) among our PWID population in London, Ontario in...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-06-01
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| Series: | Harm Reduction Journal |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12954-020-00378-z |
| _version_ | 1819162830572617728 |
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| author | Meera Shah Ryan Wong Laura Ball Klajdi Puka Charlie Tan Esfandiar Shojaei Sharon Koivu Michael Silverman |
| author_facet | Meera Shah Ryan Wong Laura Ball Klajdi Puka Charlie Tan Esfandiar Shojaei Sharon Koivu Michael Silverman |
| author_sort | Meera Shah |
| collection | DOAJ |
| description | Abstract Background The rising incidence of infective endocarditis (IE) among people who inject drugs (PWID) has been a major concern across North America. The coincident rise in IE and change of drug preference to hydromorphone controlled-release (CR) among our PWID population in London, Ontario intrigued us to study the details of injection practices leading to IE, which have not been well characterized in literature. Methods A case–control study, using one-on-one interviews to understand risk factors and injection practices associated with IE among PWID was conducted. Eligible participants included those who had injected drugs within the last 3 months, were > 18 years old and either never had or were currently admitted for an IE episode. Cases were recruited from the tertiary care centers and controls without IE were recruited from outpatient clinics and addiction clinics in London, Ontario. Results Thirty three cases (PWID IE+) and 102 controls (PWID but IE-) were interviewed. Multivariable logistic regressions showed that the odds of having IE were 4.65 times higher among females (95% CI 1.85, 12.28; p = 0.001) and 5.76 times higher among PWID who did not use clean injection equipment from the provincial distribution networks (95% CI 2.37, 14.91; p < 0.001). Injecting into multiple sites and heating hydromorphone-CR prior to injection were not found to be significantly associated with IE. Hydromorphone-CR was the most commonly injected drug in both groups (90.9% cases; 81.4% controls; p = 0.197). Discussion Our study highlights the importance of distributing clean injection materials for IE prevention. Furthermore, our study showcases that females are at higher risk of IE, which is contrary to the reported literature. Gender differences in injection techniques, which may place women at higher risk of IE, require further study. We suspect that the very high prevalence of hydromorphone-CR use made our sample size too small to identify a significant association between its use and IE, which has been established in the literature. |
| first_indexed | 2024-12-22T17:34:28Z |
| format | Article |
| id | doaj.art-266189925dc949e992c395485e71a802 |
| institution | Directory Open Access Journal |
| issn | 1477-7517 |
| language | English |
| last_indexed | 2024-12-22T17:34:28Z |
| publishDate | 2020-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Harm Reduction Journal |
| spelling | doaj.art-266189925dc949e992c395485e71a8022022-12-21T18:18:32ZengBMCHarm Reduction Journal1477-75172020-06-0117111010.1186/s12954-020-00378-zRisk factors of infective endocarditis in persons who inject drugsMeera Shah0Ryan Wong1Laura Ball2Klajdi Puka3Charlie Tan4Esfandiar Shojaei5Sharon Koivu6Michael Silverman7Schulich School of Medicine & Dentistry, Western UniversityWestern UniversitySchulich School of Medicine & Dentistry, Western UniversityDepartment of Epidemiology and Biostatistics, Western UniversityDivision of Infectious Diseases, St. Joseph’s Health Care, London Health Sciences CentreWestern UniversitySchulich School of Medicine & Dentistry, Western UniversitySchulich School of Medicine & Dentistry, Western UniversityAbstract Background The rising incidence of infective endocarditis (IE) among people who inject drugs (PWID) has been a major concern across North America. The coincident rise in IE and change of drug preference to hydromorphone controlled-release (CR) among our PWID population in London, Ontario intrigued us to study the details of injection practices leading to IE, which have not been well characterized in literature. Methods A case–control study, using one-on-one interviews to understand risk factors and injection practices associated with IE among PWID was conducted. Eligible participants included those who had injected drugs within the last 3 months, were > 18 years old and either never had or were currently admitted for an IE episode. Cases were recruited from the tertiary care centers and controls without IE were recruited from outpatient clinics and addiction clinics in London, Ontario. Results Thirty three cases (PWID IE+) and 102 controls (PWID but IE-) were interviewed. Multivariable logistic regressions showed that the odds of having IE were 4.65 times higher among females (95% CI 1.85, 12.28; p = 0.001) and 5.76 times higher among PWID who did not use clean injection equipment from the provincial distribution networks (95% CI 2.37, 14.91; p < 0.001). Injecting into multiple sites and heating hydromorphone-CR prior to injection were not found to be significantly associated with IE. Hydromorphone-CR was the most commonly injected drug in both groups (90.9% cases; 81.4% controls; p = 0.197). Discussion Our study highlights the importance of distributing clean injection materials for IE prevention. Furthermore, our study showcases that females are at higher risk of IE, which is contrary to the reported literature. Gender differences in injection techniques, which may place women at higher risk of IE, require further study. We suspect that the very high prevalence of hydromorphone-CR use made our sample size too small to identify a significant association between its use and IE, which has been established in the literature.http://link.springer.com/article/10.1186/s12954-020-00378-zInjection drug useInfective endocarditisHIVHepatitis COpioid precedenceOpioid epidemic |
| spellingShingle | Meera Shah Ryan Wong Laura Ball Klajdi Puka Charlie Tan Esfandiar Shojaei Sharon Koivu Michael Silverman Risk factors of infective endocarditis in persons who inject drugs Harm Reduction Journal Injection drug use Infective endocarditis HIV Hepatitis C Opioid precedence Opioid epidemic |
| title | Risk factors of infective endocarditis in persons who inject drugs |
| title_full | Risk factors of infective endocarditis in persons who inject drugs |
| title_fullStr | Risk factors of infective endocarditis in persons who inject drugs |
| title_full_unstemmed | Risk factors of infective endocarditis in persons who inject drugs |
| title_short | Risk factors of infective endocarditis in persons who inject drugs |
| title_sort | risk factors of infective endocarditis in persons who inject drugs |
| topic | Injection drug use Infective endocarditis HIV Hepatitis C Opioid precedence Opioid epidemic |
| url | http://link.springer.com/article/10.1186/s12954-020-00378-z |
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