UK physician co-authors guidance on treating heart infection in people who inject drugs

Infective endocarditis (IE) occurs when bacteria enter the bloodstream and settle in the heart lining, a heart valve or a blood vessel, causing serious tissue damage and other problems. Of the more than 35,000 cases a year in the U.S., about one in five people die. While the infection can be linked to a variety of risk factors, it is becoming more common in people who inject drugs due to non-sterile injection practices.

In response to the increasing incidence of infective endocarditis among people who inject drugs including opioids, stimulants or other drugs, the American Heart Association recently released guidelines on this patient population’s need for specialized care.

The scientific statement was co-authored by Laura Fanucchi, M.D., internist and addiction medicine specialist, associate professor in the University of Kentucky’s College of Medicine Division of Infectious Diseases and Center on Drug and Alcohol Research, and director of UK’s inpatient Addiction Consult and Education Service. Fanucchi is a NIH-funded physician researcher and is currently leading a clinical trial on integrated outpatient treatment of opioid use disorder and injection-related infections like endocarditis.

Fanucchi was invited to join a writing group of recognized experts in the fields of infectious diseases, cardiology, addiction medicine, and cardiovascular surgery who addressed the diagnosis, management and prevention of infective endocarditis in people who inject drugs.

The statement proposed a multidisciplinary approach to care, including evidence-based treatments to address the underlying cause of the infection, addiction.

“Treating IE without concomitant addiction treatment for substance use disorder is failing to treat the underlying cause of illness, an ideal that is a principal tenet in all other medical conditions,” said Fanucchi.

The authors highlighted the importance of early management for substance use disorder started at the time of hospitalization to minimize risks of incomplete infection treatment and to improve outcomes. This includes Food and Drug Administration-approved medications for opioid use disorder, specifically methadone and buprenorphine, which not only decrease opioid-related mortality by more than half, but also effectively manage opioid withdrawal, cravings and pain.

The statement says addiction specialists should be part of a multidisciplinary care team including cardiologists, cardiac surgeons, infectious diseases specialists, pharmacists, social workers and nurse specialists.

“Addiction medicine and addiction psychiatry expertise, although not widely available currently, are critical specialties in these teams when managing persons who inject drugs,” Fanucchi said. “Thus, health care systems need to attract individuals with addiction training and support addiction medicine consultative services, particularly in centers where persons who inject drugs with infective endocarditis are commonly seen and are expected to continue to increase.”

The UK College of Medicine and UK HealthCare are leading the way in providing multidisciplinary, integrated treatment for substance use disorders and infective endocarditis as described in the AHA Statement.

UK’s Addiction Consult and Education Service provides comprehensive care, including initiation of medications for opioid use disorder, to patients with substance use disorders who are hospitalized at UK. ACES is funded by the Kentucky Opioid Response Effort and works closely with the UK First Bridge Clinic to link patients with continued treatment after discharge, as well as with the UK Multidisciplinary Endocarditis Team (MDET) in the UK Division of Infectious Diseases.

These teams are improving patient outcomes by integrating evidence-based treatments for opioid use disorders across the care continuum, backed by a growing clinical research portfolio.