Symbolic image of a heart intertwined with intravenous needles, representing infective endocarditis and addiction.

Infective Endocarditis in Injection Drug Users: Unmasking Risks and Finding Pathways to Better Outcomes

Elliot Brynn in Health & Wellness December 2025 • 4 min read.

"New research spotlights the clinical characteristics and mortality factors associated with infective endocarditis among persons who inject drugs, emphasizing the critical need for integrated addiction treatment and optimized surgical selection."

Infective endocarditis (IE), an infection of the heart's inner lining or valves, has seen a significant shift in patient demographics. Increasingly, it affects individuals who inject drugs (PWID), a group often facing barriers to optimal medical care and specialized addiction services.

A recent study published in JAMA Network Open sheds light on the clinical characteristics and factors influencing mortality in PWID with first-episode IE. This research is crucial because it addresses the discrepancies in understanding and treating IE within this vulnerable population, especially amidst the ongoing opioid crisis.

The study compares clinical characteristics of PWID undergoing surgical versus medical management for IE and identifies key variables associated with survival rates. By examining these factors, the research aims to inform and improve treatment strategies, ultimately reducing mortality and enhancing the quality of care for PWID.

What the Research Reveals About Infective Endocarditis in PWID

Symbolic image of a heart intertwined with intravenous needles, representing infective endocarditis and addiction.

The JAMA Network Open study, led by Laura Rodger and Michael Silverman, analyzed data from 370 first-episode IE cases, with 202 involving PWID, between April 1, 2007, and March 30, 2016. The research team assessed various factors, including causative organisms, infection sites, cardiac and non-cardiac complications, addiction service referrals, and surgical versus medical management approaches. The primary goal was to pinpoint factors influencing survival among PWID.

Key findings from the study highlight:

Demographic insights: Most PWID were male (52%), with a median age of 34. A significant majority tested positive for the hepatitis C virus (69.8%).
Infection Characteristics: Right-sided infections were more common (61.4%), predominantly caused by Staphylococcus aureus (77.2%).
Treatment approaches: Surgery was performed in 19.3% of patients.
Mortality rates: The overall mortality rate was 33.7%.

Survival analysis revealed that surgical intervention and referral to addiction treatment were associated with lower mortality rates. Conversely, left-sided or bilateral infections correlated with higher mortality. These insights underscore the complex interplay of factors affecting outcomes in PWID with IE.

The Path Forward: Integrating Addiction Care and Optimizing Treatment Strategies

This study highlights critical considerations for treating infective endocarditis in PWID. The findings support integrating addiction treatment services into the care pathway, as referral to such services was associated with reduced mortality. Future research should focus on refining the criteria for surgical intervention in PWID, ensuring that the most appropriate candidates receive this potentially life-saving treatment. By addressing both the infection and the underlying addiction, healthcare providers can improve outcomes and reduce mortality in this vulnerable population.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1001/jamanetworkopen.2018.5220, Alternate LINK

Title: Clinical Characteristics And Factors Associated With Mortality In First-Episode Infective Endocarditis Among Persons Who Inject Drugs

Subject: General Medicine

Journal: JAMA Network Open

Publisher: American Medical Association (AMA)

Authors: Laura Rodger, Stephannie Dresden Glockler-Lauf, Esfandiar Shojaei, Adeel Sherazi, Brian Hallam, Sharon Koivu, Kaveri Gupta, Seyed M. Hosseini-Moghaddam, Michael Silverman

Published: 2018-11-21

Everything You Need To Know

What exactly is infective endocarditis, and why is it so relevant for people who inject drugs?

Infective endocarditis (IE) is an infection that affects the inner lining of the heart or its valves. This condition is particularly concerning among individuals who inject drugs (PWID) because they often face challenges in accessing adequate medical care and addiction treatment services, which can complicate the management and outcomes of IE. Addressing these barriers is crucial for improving survival rates and overall healthcare quality for this population.

How does surgery impact the survival rates of individuals who inject drugs and are battling infective endocarditis?

The study revealed that surgical intervention is associated with lower mortality rates in PWID with infective endocarditis. This suggests that surgery can be a life-saving option for appropriate candidates. However, the criteria for surgical intervention in PWID need further refinement to ensure that the most suitable patients receive this treatment. Factors such as the extent and location of the infection, as well as the patient's overall health and addiction status, should be carefully considered.

Why is addiction treatment so important in the overall treatment plan for people with infective endocarditis?

The study showed that referral to addiction treatment services is associated with reduced mortality in PWID with infective endocarditis. Integrated addiction care addresses the underlying issues contributing to drug use, which in turn can improve adherence to medical treatment, reduce the risk of recurrent infections, and enhance overall health outcomes. Therefore, incorporating addiction treatment into the care pathway for PWID with IE is crucial for improving their chances of survival and long-term well-being.

Why do the location of the infection matter when it comes to infective endocarditis?

The study found that left-sided or bilateral infections are correlated with higher mortality rates in PWID with infective endocarditis. This is likely because these types of infections are more complex and can lead to more severe complications, such as heart failure or systemic embolization. Right-sided infections, which are more common in PWID, may be less likely to cause these severe complications, leading to better outcomes.

What role does Staphylococcus aureus play in infective endocarditis, particularly for individuals who inject drugs?

Staphylococcus aureus is identified as the predominant causative organism in PWID with infective endocarditis. This bacterium is commonly found on the skin and can enter the bloodstream through injection drug use, leading to infection of the heart valves. Effective antibiotic treatment targeting Staphylococcus aureus is crucial for managing IE in this population. Prevention strategies, such as promoting safe injection practices and providing access to clean needles, can also help reduce the risk of infection.