Of the 299 cases, 184 (61.5%) had findings consistent with active injection drug use, and 115 cases (38.5%) showed no history of injection drug use. Injection drug use- and non-injection drug use-positive culture rates were 92.4% and 86.1%, respectively. Methicillin-resistant
S. aureus (MRSA) was more likely to occur in IDUs (OR 2.8, 95% CI 1.67–4.95
p < 0.001). MRSA was also the most common pathogen in IDUs and was identified in 77 of the 184 cases (42%). Twenty-three of the 115 (20%) cases grew MRSA in the population who did not inject drugs. Methicillin-sensitive
S. aureus (MSSA) was the second most common bacteria for the IDUs, comprising 36 out of 184 cases (19.6%). In contrast, there was no statistical significance found compared with the population that did not inject drugs, who had 17 MSSA cases out of 115 (14.8%). IDUs were more likely to be infected by
Pseudomonas species (OR 3.384, 95% CI 1.13–10.17,
p = 0.027), which occurred in 20 (19
Pseudomonas aeruginosa and 1
Pseudomonas fluorescens) of the 184 cases (10.9%) compared with the population who did not inject drugs, which had 4 out of 111 (3.5%) cases. Some bacteria were less likely to occur in IDUs, such as enterococcus infections (OR 0.32, 95% CI 0.16–0.637,
p = 0.001) and streptococcal infections (OR 0.384, CI 0.182–0.812,
p = 0.012, (Table
1). Other bacterial species were also identified but showed no statistical significance between the two populations (Table
2). IDUs also experienced more right-heart involvement versus left-sided involvement (OR 2.19, 95% CI 1.29–3.74,
p = 0.004). The IDU population had 11 cases of infected prosthetic valves. The most common bacteria was MRSA, and the most common valve being affected was the prosthetic mitral valve (Table
3). The non-IDU population had eight cases of infected valves with the most common bacteria being enterococcus, with the prosthetic aortic valve being most commonly infected (Table
4).
Table 1
Organisms with statistically significant differences between the population of IDUs compared the population of patients who do not inject drugs
MRSA | 2.8 | 1.67–4.95 | < 0.001 |
Pseudomonas | 3.38 | 1.13–10.17 | 0.027 |
Enterococcus | 0.32 | 0.16–0.637 | 0.001 |
Streptococcus | 0.384 | 0.182–0.812 | 0.012 |
Table 2
Organisms listed under the “other” category and number of cases involving each organism
Brevibacterium casei
| 1 | No |
Cornybacterium
| 1 | No |
Kocuria species | 1 | No |
Granulicatella adiacens
| 2 | 1 No 1 yes |
Legionella
| 1 | No |
Stenotrophomonas maltophilia
| 3 | 2 No 1 yes |
Enterobacter
| 2 | Yes |
Achromobacter xylosoxidans
| 1 | No |
Chryseobacterium species | 1 | No |
Bacillus species (not anthracis) | 1 | Yes |
Lactobacillus
| 2 | 1 No 1 yes |
Elizabethkingia meningoseptica
| 1 | Yes |
Table 3
Prosthetic valve and bacteria involved in the IDU population
Tricuspid | Pseudomonas | 1 |
Mitral | Candida | 1 |
Mitral | MRSA | 2 |
Mitral | Pseudomonas | 2 |
Mitral | Streptococcus | 1 |
Aortic | MRSA | 2 |
Aortic | Streptococcus | 2 |
Table 4
Prosthetic valve and bacteria involved in the non-IDU population
Tricuspid | Enterococcus | 1 |
Pulmonic | No growth | 1 |
Aortic | Enterococcus | 2 |
Aortic | Streptococcus | 2 |
Aortic | MSSA | 1 |
Mitral and aortic | Enterococcus | 1 |