Bethesda/Maryland – In the United States, there has been a significant increase in infectious endocarditis among drug users during the pandemic. The head of National Institute on Drug Abuse (NIDA) suspected in Molecular Psychiatry (2022; DOI: 10.1038/s41380-022-01903-1) that COVID-19 increases susceptibility to heart valve infections.
Endocarditis has become a rare disease since the introduction of antibiotics in richer countries. In the US, this has changed in recent years as a result of the opioid crisis. The number of patients who continue to use illicit opioids because they have become dependent, often following medical treatment, has risen sharply over the past decade. Since intravenous administration is associated with a risk of infection, the number of endocarditis diseases has also increased.
According to NIDA in Bethesda, Maryland, one in ten hospitalizations for endocarditis is now associated with injecting drug use, and incidences have continued to rise over the past 3 years. A team led by NIDA director Nora Volkow evaluated the data from the “TriNetX Analytics Network”, which has access to the billing data of 109 million US patients.
Result: While the incidence of endocarditis in people with opioid dependence was 4 per 1 million person-days in 2011, it has risen to 30 per 1 million person-days by 2022. For people addicted to cocaine, there was an increase from 5 to 23 per million person-days.
Cocaine users outnumber opioid users in the US. The drug is only partially used intravenously. Both drugs are infected via contaminated injection equipment.
Over time, there was a first peak in incidence in 2017. After that, the numbers stayed about the same. However, since the beginning of the pandemic, they have risen sharply. The new analysis found that drug addicts who had documented COVID-19 disease were twice as likely to develop endocarditis.
The hazard ratio was 2.23 (95% confidence interval 1.92 to 2.60) for opioid users and 2.24 (1.79 to 2.80) for cocaine users. A third group is probably methamphetamine users, who are not recorded in the electronic medical records.
Endocarditis often requires hospital treatment. The proportion of patients with COVID-19 who were hospitalized within 180 days of being diagnosed with endocarditis was 67.5%, compared to those without COVID-19, of whom 58.7% required hospitalization. The risk of death was also higher at 9.2% versus 8.0%, although the differences were not significant. According to Volkow, however, it can be assumed that endocarditis will take a more severe course, at least in the case of acute COVID-19. © rme/aerzteblatt.de