Drug Use-Associated Infective Endocarditis: An Emerging Public Health Issue

The incidence of drug use-associated infective endocarditis has been increasing in direct correlation with the growth of the opioid epidemic.

  Living with infective endocarditis

When dentists hear the words infective endocarditis (IE), they often reflexively think of the same precaution: prophylactic antibiotics before dental treatment, 2g Amoxicillin or 500mg Clindamycin. IE is one of the few diseases our patients may develop following bacteremia from invasive dental procedures, but thankfully, its incidence is relatively rare.

 America’s opioid crisis has become an “epidemic of epidemics”

Rising intravenous drug use has created new public health epidemics of hepatitis C and deadly bacterial infections.

 Endocarditis: Are You At Risk For This 'Silent Killer'?

Endocarditis is an uncommon but potentially deadly disease of the heart. Sometimes deemed a "silent killer," its early symptoms can be relatively mild, causing some people to delay seeking care. But not getting prompt treatment can lead to devastating consequences.

 Further Evidence Against Dental Care as Endocarditis Risk

Two parallel studies find no increase in endocarditis incidence after invasive dental procedures, even among high-risk patients.

 How Many Chances Are Too Many? Treating Recurrent Infective Endocarditis in IV Drug Users

How many second chances should a drug user get? As many as it takes for us — physicians, society, government, and the healthcare system — to get it right.

 Infective Endocarditis: Why You Need to Take This Heart Infection Seriously

Knowing symptoms + acting quickly could save your life.

 Injecting Drugs Can Ruin a Heart. How Many Second Chances Should a User Get?

A life-threatening heart infection afflicts a growing number of people who inject opioids or meth. Costly surgery can fix it, but the addiction often goes unaddressed.

To give, or not to give, infective endocarditis prophylaxis

A 52 year old woman is scheduled to undergo double valve replacement surgery for severe mitral stenosis and severe aortic regurgitation. She has no other comorbidities. As part of the routine preoperative evaluation a dental consultation is obtained. She is found to have dental caries in one premolar and the dentist advises extraction of the tooth. Would you advise periprocedural infective endocarditis prophylaxis?

What is Endocarditis and What Causes It?

Symptoms of endocarditis may develop slowly or suddenly. Fever, chills, and sweating are frequent symptoms. These sometimes can be present for days before any other symptoms appear. They can also come and go or be more noticeable at nighttime. You may also have fatigue, weakness, and aches and pains in the muscles or joints. Other signs can include: •Small areas of bleeding under the nails (also known as splinter hemorrhages) •Red, painless skin spots on the palms and soles (Janeway lesions) •Red, painful nodes in the pads of the fingers and toes (Osler's nodes) •Shortness of breath with activity •Swelling of feet, legs, abdomen

Cavity-Causing Bacteria Linked To Endocarditis

We have long ago heard that gum disease may be linked to heart disease, but now due to recent discoveries made at the University of Rochester, there is even more evidence to shed light on why and how our oral health may affect the heart.

Infective Endocarditis

Acute Infective Endocarditis usually comes on suddenly and may become life-threatening within a matter of days. This type of Infective Endocarditis is usually caused by staphylococci, streptococci, pneumococci, or gonococci bacteria.

Infective Endocarditis Empiric Therapy

Generally, empiric therapy is not instituted in suspected cases of subacute endocarditis until the etiology is identified by blood cultures. If blood cultures are negative but endocarditis is still considered likely, therapy is chosen based on the most likely etiology. Acute endocarditis is usually due to Staphylococcus aureus infection (both methicillin-susceptible and methicillin-resistant), streptococci, and enterococci. Empiric therapy for such infections would generally be vancomycin until culture results become available.

Preventing Bacterial Endocarditis

The American Academy of Family Physicians is one of the largest national medical organizations, representing more than 94,000 family physicians, family medicine residents, and medical students nationwide. Founded in 1947, its mission has been to preserve and promote the science and art of family medicine and to ensure high-quality, cost-effective health care for patients of all ages.