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Comment & Response
November 13, 2018

Injection Drug Use-Associated Infective Endocarditis—Reply

Author Affiliations
  • 1Division of Cardiology, Duke University Medical Center, Durham, North Carolina
  • 2Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina
  • 3Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
JAMA. 2018;320(18):1939-1940. doi:10.1001/jama.2018.14075

In Reply In discussing the topic of injection drug use–associated infective endocarditis in our review,1 our intent was to highlight the lack of certainty with respect to the use of surgery and outcomes in these patients. Cardiac surgery in patients with injection drug use–associated infective endocarditis has been associated with higher mortality and reoperation in the first 6 months after surgery than in patients with infective endocarditis not related to injection drug use.2 Surgical decision-making about infective endocarditis is complicated in general. For example, approximately 1 in 4 patients with infective endocarditis (regardless of whether they use intravenous drugs) with indications for surgery do not receive surgery as part of their management, particularly those with infective endocarditis due to Staphylococcus aureus.3 An important and challenging aspect of managing infective endocarditis is addressing host factors that impede the use of surgery when indications are present. With injection drug use–associated infective endocarditis, the risks of ongoing addiction, injection drug use, and infection relapse or recurrence adds greater complexity that needs to be addressed. We agree that addiction treatment is a crucial aspect of care for patients with injection drug use–associated infective endocarditis and is often suboptimally addressed.4 Also, we regret if readers perceived any unintended negativity or judgment with respect to the terminology used in our brief discussion of injection drug use–associated infective endocarditis.

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