Background The optimal treatment strategy for intravenous drug users (IVDU) with infective endocarditis (IE) is controversial. We therefore sought to investigate outcomes among IVDUs after surgery for IE.

Methods We retrospectively reviewed all 192 consecutive patients who underwent an operation for IE between 2005 and 2016 in the Helsinki University Hospital. Forty-seven patients (24.5%) were IVDUs and 145 (75.5%) were non-IVDUs. Mortality and reinfection and reoperation rates were evaluated.

Results IVDUs were younger (29.9 vs. 63.8 years, p < 0.001) and had less cardiovascular risk factors and lower EuroSCORE II (4.3 vs. 7.3%, p < 0.001), but Staphylococcus aureus infection (66.0 vs. 23.4%, p < 0.001), tricuspid valve endocarditis (34.0 vs. 2.8%, p < 0.001), and liver disease (63.8 vs. 2.8%, p < 0.001) occurred more often in IVDUs than in non-IVDUs. Thirty-day mortality of IVDUs was 8.5% and that of non-IVDUs was 6.9% (p = 0.711). Survival of IVDUs at 5 years was 70.8 ± 7.4% and survival of non-IVDUs was 67.9 ± 4.7% (p = 0.678). Relative to an age- and sex-matched general population, IVDUs had 58.6 (95% confidence interval [CI]: 33.7–101.9; p < 0.001) and non-IVUD 4.4 (95% CI: 3.1–6.2; p < 0.001) standardized mortality ratio. IVDUs had a higher reinfection rate at 5 years (25.8 ± 7.7% vs. 3.0 ± 1.7%, p < 0.001) and a higher early reoperation rate than non-IVDUs (10.6 vs. 1.4%, p = 0.003).

Conclusions IVDUs and non-IVDUs had comparable survival at 5 years, but IVDUs had a very significantly increased risk of death in comparison to an age- and sex-matched general population. IVDUs had higher reinfection and early reoperation rates. Survival was poor after medically treated reinfection.

背景 感染性心内膜炎 (IE) 静脉吸毒者 (IVDU) 的最佳治疗策略存在争议。因此，我们试图调查 IE 手术后 IVDU 的结果。

方法 我们回顾性分析了 2005 年至 2016 年间在赫尔辛基大学医院接受 IE 手术的所有 192 名连续患者。47 名患者 (24.5%) 为 IVDU，145 名 (75.5%) 为非 IVDU。评估了死亡率、再感染率和再手术率。

结果 IVDUs 更年轻（29.9 对 63.8 岁，p  < 0.001），心血管危险因素较少，EuroSCORE II 较低（4.3 对 7.3%，p  < 0.001），但金黄色葡萄球菌感染（66.0 对 23.4%，p  < 0.001）、三尖瓣心内膜炎（34.0 对 2.8%，p  < 0.001）和肝病（63.8 对 2.8%，p  < 0.001）在 IVDU 中的发生率高于非 IVDU。IVDU 的 30 天死亡率为 8.5%，非 IVDU 的死亡率为 6.9% ( p  = 0.711)。IVDU 的 5 年存活率为 70.8 ± 7.4%，非 IVDU 的存活率为 67.9 ± 4.7% ( p = 0.678）。相对于年龄和性别匹配的一般人群，IVDU 有 58.6（95% 置信区间 [CI]：33.7-101.9；p  < 0.001）和非 IVUD 4.4（95% CI：3.1-6.2；p  < 0.001）标准化死亡率。IVDU 的 5 年再感染率更高（25.8 ± 7.7% vs. 3.0 ± 1.7%，p  < 0.001），早期再手术率高于非 IVDU（10.6 vs. 1.4%，p  = 0.003）。

结论 IVDUs 和非 IVDUs 的 5 年生存率相当，但与年龄和性别匹配的一般人群相比，IVDUs 的死亡风险显着增加。IVDU 的再感染率和早期再手术率更高。药物治疗再感染后存活率很低。