The Incidence, Clinical Characteristics and Outcome of Infective Endocarditis Among Intravenous Drug Abusers Versus Non-Drug Abusers.

Infective endocarditis (IE) is the infection of the endocardial surface of the heart mainly affecting the valves of the heart. It is still associated with very high morbidity and mortality all over the world despite various advances in diagnostic and treatment methods.

A few studies have shown that infective endocarditis represents less than 0.5% of adult cardiovascular admissions.While the overall incidence of IE has remained stable over the last several years, IE has increased in young people in parallel with injection drug use (IDU) behaviours and the growing opioid crisis.

According to recent guidelines , Intravenous (IV) drug use is considered a minor Duke criteria for the diagnosis of infective endocarditis.

Compared to the general population, intravenous drug abuse (IVDA) is associated with an up to 100-fold increased risk of IE through several mechanisms, including endothelial injury from injected particulate matter, direct injection of contaminated material, and drug-associated vasospasm leading to intimal damage and thrombus formation.

Also, IVDA is associated with HIV outbreaks, which is a well-known risk factor for IE. HIV-associated IE is associated with high rates of morbidity and mortality than non-HIV-associated IE.Because of its pathophysiology, IVDA-associated IE is more commonly right-sided. Beyond these known characteristics, however, literature on this topic is substantially limited, including the clinical and microbiological characteristics of these patients, rate and types of complications and outcomes.

• Echocardiography, Urine analysis , blood culture (Diagnostic test): All patients will be investigated by ECG, Urine analysis, blood culture , Echocardiography

Primary outcomes

• The incidence of IVDA among IE patients [Baseline]: Report the incidence of IVDA among IE patients, describe their clinical and microbiological characteristics comparison to the IE in non - IVDA.
• The complications of IVDA among IE patients [Baseline]: Report the rates and types of complications

Secondary outcomes

• The psychiatric characteristics of the addict group [Baseline]: This will be done by psychiatric questionnaires: -Addiction Severity Index questionnaire to measure severity of the addiction on the patient
• The Withdrawal symptoms of the study group [Baseline]: This will be done by psychiatric questionnaires: -Withdrawal symptoms questionnaire that occur to the patient after stop of the addiction
• The psychiatric characteristics of the study group [Baseline]: This will be done by psychiatric questionnaires: -Symptom Check List 90 to measure other comorbidities
• The personality characteristics of the study group [Baseline]: This will be done by psychiatric questionnaires: -Eysenck Personality questionnaire to measure personality.

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* Adult Patients (>18 years) with definite or possible IE.

Exclusion Criteria:

* Patients with rejected diagnosis of infective endocarditis after workup, according to modified Duke's criteria.

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• Yehia Kish, Study director, Assiut University