Diagnoses of infective endocarditis, a life-threatening
bacterial infection of the heart valves, have become more common over the past
ten years among people with hepatitis C and people with opioid use disorder in
the United States, but cases fell among people living with HIV, a large study published
in the journal Clinical Infectious Diseases shows.
Infective endocarditis is caused by bacteria entering the bloodstream,
often through injecting drug use. Infective endocarditis can lead to heart failure
or stroke and is a common cause of death in people who inject drugs.
To investigate the prevalence of infective endocarditis,
investigators from the US Centers for Disease Control and Prevention looked at
commercial and Medicaid public health insurance databases to find cases of
infective endocarditis between 2007 and 2017. They used the databases to
produce weighted incidence estimates based on the US population for each year
from 2007 to 2017. The databases covered around 26 million people insured
through employer insurance and around 20% of people who qualify for Medicaid,
public insurance for people with low incomes, the elderly and people with
They estimated an annual incidence of 13.1 cases per 100,000
persons in 2007 and 13.8 cases per 100,000 in 2017 in people with commercial insurance,
a non-significant increase.
Cases increased in people with hepatitis C, from 172.4 per
100,000 in 2007 to 238.2 per 100,000 in 2017, an annual increase of 3.2%. Cases
also increased in people with opioid use disorders, from 199.5 per 100,000 in
2007 to 357.1 per 100,000 in 2017, an annual increase of 5.7%. Cases also
increased in young people aged 18-29 (6.6% per year) and in rural areas (2.7%
“This increase appears to parallel the ongoing national
opioid crisis,” the study authors wrote.
Cases declined in people with HIV, from 148 per 100,000 to
112 per 100,000, a 4.3% annual decline.
Infective endocarditis can be prevented by use of sterile
injecting equipment and hand hygiene. Harm Reduction Coalition’s Getting
Off Right Safety Manual explains harm reduction methods to reduce the risk
of bacterial infection.
Harm reduction programmes that provide access to sterile injecting
equipment including needles and syringes, cookers, filters and water, as well
as alcohol swabs to clean the injection site and hand wash to minimise bacterial
contamination can help to prevent bacterial endocarditis, the study authors
Harm reduction programmes that provide sterile injecting
equipment also have the potential to provide treatment for minor bacterial skin
infections and educate clients on prevention of bacterial infections.
Among healthcare providers, a diagnosis of infective endocarditis
– or any bacterial skin infection – should prompt the offer of testing for HIV
and hepatitis C, as well as discussion of substance use disorder treatment
options including opioid substitution therapy, concluded
authors of a previously published study also drawing on commercial insurance
data. They found that only 8% of people who inject drugs in the US who presented for medical care were offered a
test for hepatitis C between 2010 and 2017, and people receiving medical
attention for bacterial skin infections or endocarditis were significantly less
likely to be tested.