Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Original Article

Volume 14, Number 3, June 2023, pages 176-182

Prevalence of Right- and Left-Sided Endocarditis Among Intravenous Drug Use Patients at a Large Academic Medical Center

**Table 1.** Baseline Characteristics
N (%)	Group 1 (N = 114)	Group 2 (N = 25)	Group 3 (N = 58)	Overall (N = 197)	P-value
Data are presented as means and standard deviations (SDs) in parentheses or numbers with percentage in parentheses. *Significant P-values. ALT: alanine transaminase; AST: aspartate aminotransferase; CIEDs: cardiac implantable electrical devices; CRP: C-reactive protein; DBP: diastolic blood pressure; ESR: erythrocyte sedimentation rate; HIV: human immunodeficiency virus; HR: heart rate; SBP: systolic blood pressure; WBC: white blood cell.
Age (years), mean (SD)	33.2 (8.0)	36 (7.6)	38.6 (9.8)	35.1 (8.8)	0.002*
Sex					< 0.001*
Male	34 (29.8)	15 (60.0)	35 (60.3)	84 (42.6)
Female	80 (70.2)	10 (40.0)	23 (39.7)	113 (57.4)
Race					0.097
Black/AA	3 (2.6)	1 (4.0)	0 (0.0)	4 (2.0)
Caucasian	111 (97.4)	23 (92.0)	57 (98.3)	191 (97.0)
Refused/unreported	0 (0.0)	1 (4.0)	1 (1.7)	2 (1.0)
Medical conditions
Diabetes mellitus	3 (3.3)	3 (13.0)	8 (14.0)	13 (7.7)	0.010*
Hypertension	31 (27.2)	13 (52.0)	28 (48.3)	72 (36.5)	0.006*
Dyslipidemia	5 (4.4)	2 (8.0)	8 (13.8)	15 (7.6)	0.085
HIV	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	N/A
Ischemic heart disease	5 (4.4)	6 (24.0)	13 (22.4)	24 (12.2)	< 0.001*
Procedures
Valvular interventions	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	N/A
CIEDs	29 (25.4)	13 (52.0)	29 (50.0)	71 (36.0)	0.001*
Substance use
Tobacco	92 (86.8)	18 (78.3)	46 (83.6)	156 (84.8)	0.487
Opioid	90 (78.9)	14 (56.0)	40 (69.0)	144 (73.1)	0.045*
Amphetamine	49 (43.0)	7 (28.0)	20 (34.5)	76 (38.6)	0.283
Cocaine	11 (9.6)	1 (4.4)	5 (8.6)	18 (9.1)	1.000
Cannabinoids	24 (21.1)	4 (16.0)	13 (22.4)	41 (20.8)	0.800
Last drug use (days)	108.6 (395.3)	11.0 (14.1)	35.9 (92.0)	82.3 (323.1)	0.238
Labs
Hemoglobin (g/dL)	9.9 (2.3)	9.7 (2.4)	10.3 (2.1)	10.0 (2.2)	0.385
WBC (× 10⁹/L)	13.1 (6.5)	12.0 (5.0)	14.0 (6.4)	13.2 (6.3)	0.305
Creatinine (mg/dL)	1.0 (0.9)	1.0 (0.5)	1.1 (1.1)	1.0 (1.0)	0.978
HbA1c (%)	5.9 (2.0)	6.3 (2.5)	5.6 (0.8)	5.8 (1.6)	0.477
AST (U/L)	36.4 (37.8)	46.4 (37.5)	46.9 (58.3)	41.0 (45.2)	0.298
ALT (U/L)	31.1 (62.4)	45.4 (53.3)	50.0 (119.2)	38.9 (83.3)	0.339
CRP (µg/mL)	27.1 (59.2)	20.5 (28.3)	18.5 (45.8)	24.1 (53.1)	0.663
ESR (mm/h)	60.6 (27.3)	62.0 (41.9)	68.0 (33.0)	62.6 (30.6)	0.785
Vitals
Temperature (°C)	37.1 (0.7)	37.0 (1.1)	37.1 (0.8)	37.1 (0.8)	0.959
SBP (mm Hg)	114.9 (18.9)	119.7 (16.5)	123.6 (23.9)	118.1 (20.5)	0.050*
DBP (mm Hg)	70.9 (11.0)	70.9 (11.0)	73.8 (18.0)	72.5 (15.6)	0.669
HR (bpm)	104.1 (19.4)	109.6 (16.1)	97.5 (18.2)	102.8 (19.0)	0.010*
SpO₂ (%)	96.9 (2.3)	96.0 (2.8)	96.7 (3.5)	97.6 (2.8)	0.343

Table 1. Baseline Characteristics

N (%)

Group 1 (N = 114)

Group 2 (N = 25)

Group 3 (N = 58)

Overall (N = 197)

P-value

Data are presented as means and standard deviations (SDs) in parentheses or numbers with percentage in parentheses. *Significant P-values. ALT: alanine transaminase; AST: aspartate aminotransferase; CIEDs: cardiac implantable electrical devices; CRP: C-reactive protein; DBP: diastolic blood pressure; ESR: erythrocyte sedimentation rate; HIV: human immunodeficiency virus; HR: heart rate; SBP: systolic blood pressure; WBC: white blood cell.

Age (years), mean (SD)

33.2 (8.0)

36 (7.6)

38.6 (9.8)

35.1 (8.8)

0.002*

Sex

< 0.001*

Male

34 (29.8)

15 (60.0)

35 (60.3)

84 (42.6)

Female

80 (70.2)

10 (40.0)

23 (39.7)

113 (57.4)

Race

0.097

Black/AA

3 (2.6)

1 (4.0)

0 (0.0)

4 (2.0)

Caucasian

111 (97.4)

23 (92.0)

57 (98.3)

191 (97.0)

Refused/unreported

0 (0.0)

1 (4.0)

1 (1.7)

2 (1.0)

Medical conditions

Diabetes mellitus

3 (3.3)

3 (13.0)

8 (14.0)

13 (7.7)

0.010*

Hypertension

31 (27.2)

13 (52.0)

28 (48.3)

72 (36.5)

0.006*

Dyslipidemia

5 (4.4)

2 (8.0)

8 (13.8)

15 (7.6)

0.085

HIV

0 (0.0)

N/A

Ischemic heart disease

5 (4.4)

6 (24.0)

13 (22.4)

24 (12.2)

< 0.001*

Procedures

Valvular interventions

0 (0.0)

N/A

CIEDs

29 (25.4)

13 (52.0)

29 (50.0)

71 (36.0)

0.001*

Substance use

Tobacco

92 (86.8)

18 (78.3)

46 (83.6)

156 (84.8)

0.487

Opioid

90 (78.9)

14 (56.0)

40 (69.0)

144 (73.1)

0.045*

Amphetamine

49 (43.0)

7 (28.0)

20 (34.5)

76 (38.6)

0.283

Cocaine

11 (9.6)

1 (4.4)

5 (8.6)

18 (9.1)

1.000

Cannabinoids

24 (21.1)

4 (16.0)

13 (22.4)

41 (20.8)

0.800

Last drug use (days)

108.6 (395.3)

11.0 (14.1)

35.9 (92.0)

82.3 (323.1)

0.238

Labs

Hemoglobin (g/dL)

9.9 (2.3)

9.7 (2.4)

10.3 (2.1)

10.0 (2.2)

0.385

WBC (× 10⁹/L)

13.1 (6.5)

12.0 (5.0)

14.0 (6.4)

13.2 (6.3)

0.305

Creatinine (mg/dL)

1.0 (0.9)

1.0 (0.5)

1.1 (1.1)

1.0 (1.0)

0.978

HbA1c (%)

5.9 (2.0)

6.3 (2.5)

5.6 (0.8)

5.8 (1.6)

0.477

AST (U/L)

36.4 (37.8)

46.4 (37.5)

46.9 (58.3)

41.0 (45.2)

0.298

ALT (U/L)

31.1 (62.4)

45.4 (53.3)

50.0 (119.2)

38.9 (83.3)

0.339

CRP (µg/mL)

27.1 (59.2)

20.5 (28.3)

18.5 (45.8)

24.1 (53.1)

0.663

ESR (mm/h)

60.6 (27.3)

62.0 (41.9)

68.0 (33.0)

62.6 (30.6)

0.785

Vitals

Temperature (°C)

37.1 (0.7)

37.0 (1.1)

37.1 (0.8)

0.959

SBP (mm Hg)

114.9 (18.9)

119.7 (16.5)

123.6 (23.9)

118.1 (20.5)

0.050*

DBP (mm Hg)

70.9 (11.0)

73.8 (18.0)

72.5 (15.6)

0.669

HR (bpm)

104.1 (19.4)

109.6 (16.1)

97.5 (18.2)

102.8 (19.0)

0.010*

SpO₂ (%)

96.9 (2.3)

96.0 (2.8)

96.7 (3.5)

97.6 (2.8)

0.343

**Table 2.** Bacteriology and Echocardiographic Parameters
	Group 1 (N = 114)	Group 2 (N = 25)	Group 3 (N = 58)	Overall (N = 197)	P-value
Significant P-values. MSSA: methicillin-susceptible Staphylococcus aureus; MRSA: methicillin-resistant Staphylococcus aureus*; TEE: transesophageal echocardiography; TTE: transthoracic echocardiogram; LVEF: left ventricular ejection fraction; SD: standard deviation; TRVmax: tricuspid valve regurgitation maximum velocity; TS: tricuspid stenosis; TR: tricuspid regurgitation; PS: pulmonary stenosis; PR: pulmonary regurgitation; AS: aortic stenosis; AR: aortic regurgitation; MS: mitral stenosis; MR: mitral regurgitation; ASD: atrial septal defect; PFO: patent foramen ovale; VSD: ventricular septal defect; PDA: patent ductus arteriosus.
Bacteremia	92 (80.7)	24 (96.0)	46 (79.3)	162 (82.2)	0.137
Days with bacteremia	4.2 (3.5)	4.9 (2.3)	4.0 (4.0)	4.2 (3.5)	0.592
Bacteria, N (%)					0.002*
MSSA	32 (30.8)	6 (25.0)	9 (16.7)	47 (25.8)
MRSA	45 (43.3)	12 (50.0)	13 (24.1)	70 (38.5)
Streptococci	4 (3.8)	0 (0.0)	10 (18.6)	14 (7.6)
E. faecalis	2 (1.9)	3 (12.5)	7 (13.0)	12 (6.6)
Pseudomonas spp.	0 (0.0)	1 (4.2)	2 (3.8)	3 (1.6)
Others	7 (6.7)	2 (8.3)	4 (7.4)	13 (7.1)
Polymicrobial	2 (1.9)	0 (0.0)	2 (3.7)	4 (2.2)
Culture-negative	3 (2.9)	0 (0.0)	0 (0.0)	3 (1.6)
Echo					0.011*
TTE	98 (86.0)	16 (67.0)	41 (70.7)	155 (78.7)
TEE	16 (14.0)	9 (36.0)	17 (29.3)	42 (21.3)
With bubbles	6 (5.4)	3 (12.5)	8 (14.0)	17 (8.9)	0.117
Valve types					0.164
Native	95 (84.1)	20 (80.0)	43 (74.1)	158 (80.6)
Bioprosthetic	18 (15.9)	1 (16.0)	14 (24.1)	36 (18.4)
Mechanical	0 (0.0)	1 (4.0)	1 (1.7)	2 (1.0)
Valve involvement
Tricuspid	111 (97.4)	24 (96.0)	0 (0.0)	135 (68.5)	< 0.001*
Pulmonic	9 (7.9)	4 (16.0)	0 (0.0)	13 (6.6)	0.009*
Mitral	0 (0.0)	18 (72.0)	28 (48.3)	46 (23.4)	< 0.001*
Aortic	0 (0.0)	11 (44.0)	33 (56.9)	44 (22.3)	< 0.001*
LVEF (%), mean (SD)	53.0 (12.1)	46.4 (17.9)	49.6 (14.7)	51.2 (13.8)	0.125
TRVmax (m/s)	2.7 (0.5)	2.9 (0.5)	3.1 (1.3)	2.8 (0.8)	0.098
Tricuspid abnormalities
TS					0.497
Trivial-mild	0 (0.0)	0 (0.0)	1 (1.7)	1 (0.5)
Moderate	4 (3.6)	0 (0.0)	0 (0.0)	4 (2.1)
Severe	1 (0.9)	0 (0.0)	0 (0.0)	1 (0.5)
TR					< 0.001*
Trivial-mild	31 (27.4)	10 (40.0)	23 (39.6)	64 (32.7)
Moderate	35 (31.0)	3 (12.0)	8 (13.8)	46 (23.5)
Severe	41 (36.3)	10 (40.0)	1 (1.7)	52 (26.5)
Pulmonic abnormalities
PS					1.000
Trivial-mild	2 (1.8)	0 (0.0)	0 (0.0)	2 (1.0)
Moderate	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)
Severe	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)
PR					0.697
Trivial-mild	37 (33.0)	5 (20.0)	19 (32.8)	61 (31.3)
Moderate	1 (0.9)	0 (0.0)	1 (1.7)	2 (1.0)
Severe	2 (1.8)	0 (0.0)	0 (0.0)	2 (1.0)
Mitral abnormalities
MS					0.086
Trivial-mild	0 (0.0)	1 (4.0)	1 (1.7)	2 (1.0)
Moderate	0 (0.0)	0 (0.0)	1 (1.7)	1 (0.5)
Severe	0 (0.0)	0 (0.0)	1 (1.7)	1 (0.5)
MR					< 0.001*
Trivial-mild	51 (45.2)	12 (48.0)	16 (28.5)	79 (40.7)
Moderate	2 (1.8)	3 (12.0)	12 (21.4)	17 (8.8)
Severe	0 (0.0)	3 (12.0)	12 (21.4)	15 (7.7)
Aortic abnormalities
AS					0.073
Trivial-mild	0 (0.0)	0 (0.0)	4 (6.9)	4 (2.0)
Moderate	1 (0.9)	0 (0.0)	1 (1.7)	2 (1.0)
Severe	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)
AR					< 0.001*
Trivial-mild	2 (1.8)	2 (8.0)	7 (12.0)	11 (5.7)
Moderate	1 (0.9)	2 (8.0)	5 (8.6)	8 (4.1)
Severe	0 (0.0)	8 (32.0)	19 (32.8)	27 (13.8)
Valve perforation	10 (9.0)	11 (47.8)	14 (24.6)	35 (18.3)	< 0.001*
Shunts
ASD	2 (2.8)	0 (0)	1 (2.6)	3 (2.4)	1.000
PFO	5 (7.1)	5 (31.2)	6 (16.7)	16 (3.1)	0.021*
VSD	0 (0)	0 (0)	0 (0)	0 (0)	N/A
PDA	0 (0)	0 (0)	0 (0)	0 (0)	N/A

Table 2. Bacteriology and Echocardiographic Parameters

Group 1 (N = 114)

Group 2 (N = 25)

Group 3 (N = 58)

Overall (N = 197)

P-value

*Significant P-values. MSSA: methicillin-susceptible Staphylococcus aureus; MRSA: methicillin-resistant Staphylococcus aureus; TEE: transesophageal echocardiography; TTE: transthoracic echocardiogram; LVEF: left ventricular ejection fraction; SD: standard deviation; TRVmax: tricuspid valve regurgitation maximum velocity; TS: tricuspid stenosis; TR: tricuspid regurgitation; PS: pulmonary stenosis; PR: pulmonary regurgitation; AS: aortic stenosis; AR: aortic regurgitation; MS: mitral stenosis; MR: mitral regurgitation; ASD: atrial septal defect; PFO: patent foramen ovale; VSD: ventricular septal defect; PDA: patent ductus arteriosus.

Bacteremia

92 (80.7)

24 (96.0)

46 (79.3)

162 (82.2)

0.137

Days with bacteremia

4.2 (3.5)

4.9 (2.3)

4.0 (4.0)

4.2 (3.5)

0.592

Bacteria, N (%)

0.002*

MSSA

32 (30.8)

6 (25.0)

9 (16.7)

47 (25.8)

MRSA

45 (43.3)

12 (50.0)

13 (24.1)

70 (38.5)

Streptococci

4 (3.8)

0 (0.0)

10 (18.6)

14 (7.6)

E. faecalis

2 (1.9)

3 (12.5)

7 (13.0)

12 (6.6)

Pseudomonas spp.

0 (0.0)

1 (4.2)

2 (3.8)

3 (1.6)

Others

7 (6.7)

2 (8.3)

4 (7.4)

13 (7.1)

Polymicrobial

2 (1.9)

0 (0.0)

2 (3.7)

4 (2.2)

Culture-negative

3 (2.9)

0 (0.0)

3 (1.6)

Echo

0.011*

TTE

98 (86.0)

16 (67.0)

41 (70.7)

155 (78.7)

TEE

16 (14.0)

9 (36.0)

17 (29.3)

42 (21.3)

With bubbles

6 (5.4)

3 (12.5)

8 (14.0)

17 (8.9)

0.117

Valve types

0.164

Native

95 (84.1)

20 (80.0)

43 (74.1)

158 (80.6)

Bioprosthetic

18 (15.9)

1 (16.0)

14 (24.1)

36 (18.4)

Mechanical

0 (0.0)

1 (4.0)

1 (1.7)

2 (1.0)

Valve involvement

Tricuspid

111 (97.4)

24 (96.0)

0 (0.0)

135 (68.5)

< 0.001*

Pulmonic

9 (7.9)

4 (16.0)

0 (0.0)

13 (6.6)

0.009*

Mitral

0 (0.0)

18 (72.0)

28 (48.3)

46 (23.4)

< 0.001*

Aortic

0 (0.0)

11 (44.0)

33 (56.9)

44 (22.3)

< 0.001*

LVEF (%), mean (SD)

53.0 (12.1)

46.4 (17.9)

49.6 (14.7)

51.2 (13.8)

0.125

TRVmax (m/s)

2.7 (0.5)

2.9 (0.5)

3.1 (1.3)

2.8 (0.8)

0.098

Tricuspid abnormalities

0.497

Trivial-mild

0 (0.0)

1 (1.7)

1 (0.5)

Moderate

4 (3.6)

0 (0.0)

4 (2.1)

Severe

1 (0.9)

0 (0.0)

1 (0.5)

< 0.001*

Trivial-mild

31 (27.4)

10 (40.0)

23 (39.6)

64 (32.7)

Moderate

35 (31.0)

3 (12.0)

8 (13.8)

46 (23.5)

Severe

41 (36.3)

10 (40.0)

1 (1.7)

52 (26.5)

Pulmonic abnormalities

1.000

Trivial-mild

2 (1.8)

0 (0.0)

2 (1.0)

Moderate

0 (0.0)

Severe

0 (0.0)

0.697

Trivial-mild

37 (33.0)

5 (20.0)

19 (32.8)

61 (31.3)

Moderate

1 (0.9)

0 (0.0)

1 (1.7)

2 (1.0)

Severe

2 (1.8)

0 (0.0)

2 (1.0)

Mitral abnormalities

0.086

Trivial-mild

0 (0.0)

1 (4.0)

1 (1.7)

2 (1.0)

Moderate

0 (0.0)

1 (1.7)

1 (0.5)

Severe

0 (0.0)

1 (1.7)

1 (0.5)

< 0.001*

Trivial-mild

51 (45.2)

12 (48.0)

16 (28.5)

79 (40.7)

Moderate

2 (1.8)

3 (12.0)

12 (21.4)

17 (8.8)

Severe

0 (0.0)

3 (12.0)

12 (21.4)

15 (7.7)

Aortic abnormalities

0.073

Trivial-mild

0 (0.0)

4 (6.9)

4 (2.0)

Moderate

1 (0.9)

0 (0.0)

1 (1.7)

2 (1.0)

Severe

0 (0.0)

< 0.001*

Trivial-mild

2 (1.8)

2 (8.0)

7 (12.0)

11 (5.7)

Moderate

1 (0.9)

2 (8.0)

5 (8.6)

8 (4.1)

Severe

0 (0.0)

8 (32.0)

19 (32.8)

27 (13.8)

Valve perforation

10 (9.0)

11 (47.8)

14 (24.6)

35 (18.3)

< 0.001*

Shunts

ASD

2 (2.8)

0 (0)

1 (2.6)

3 (2.4)

1.000

PFO

5 (7.1)

5 (31.2)

6 (16.7)

16 (3.1)

0.021*

VSD

0 (0)

N/A

PDA

0 (0)

N/A

**Table 3.** Inpatient Surgical and Interventional Outcomes
	Group 1 (N = 114)	Group 2 (N = 25)	Group 3 (N = 58)	Overall (N = 197)	P-value
*Significant P-values.
Valve surgeries	14 (12.4)	9 (37.5)	22 (37.9)	45 (23.1)	< 0.001*
Angiovac	16 (14.3)	2 (8.3)	0 (0)	18 (9.3)	0.002*
All-cause mortality	3 (2.6)	4 (30.8)	15 (25.9)	21 (10.7)	< 0.001*

Table 3. Inpatient Surgical and Interventional Outcomes

Group 1 (N = 114)

Group 2 (N = 25)

Group 3 (N = 58)

Overall (N = 197)

P-value

*Significant P-values.

Valve surgeries

14 (12.4)

9 (37.5)

22 (37.9)

45 (23.1)

< 0.001*

Angiovac

16 (14.3)

2 (8.3)

0 (0)

18 (9.3)

0.002*

All-cause mortality

3 (2.6)

4 (30.8)

15 (25.9)

21 (10.7)

< 0.001*