Evolving spectrum and outcomes of infective endocarditis in North India: A comparative analysis between people who inject drugs and those who do not.

IF 2 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Indian heart journal Pub Date : 2026-06-23 DOI:10.1016/j.ihj.2026.06.006

Keshav Sachdeva, Jasneet Kaur, Ananta Kanwar, Abhishek Goyal, Gautam Singal, Akash Batta, Anshuman Gupta, Shibba Takkar Chhabra, Naved Aslam, Gurveer Singh Raien, Pranav Ahuja, Raagini Gupta, Jasmine Arora, Vatsalya Grover, Gurpreet Singh Wander, Bishav Mohan

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Abstract

Background: Infective endocarditis (IE) data from South Asia remain limited, particularly among people who inject drugs (PWID). North India faces a growing injection drug burden, yet comparative IE data between PWID and non-PWID populations are scarce.

Methods: This retrospective cohort study with prospective long-term follow-up was conducted at a tertiary center in Ludhiana, Punjab, India. Patients meeting modified Duke criteria for definite IE (January 2017-December 2021) were compared between PWID (n = 62) and non-PWID (n = 101) groups. Multivariate logistic regression identified in-hospital mortality predictors. Five-year vital status was ascertained by telephone contact.

Results: PWID were younger (29.2 ± 7.5 vs. 45.0 ± 15.4 years, p = 0.001), predominantly male (98.4% vs. 64.4%), and had higher hepatitis C co-infection (54.8% vs. 5.9%). Blood culture positivity was greater in PWID (74.2% vs. 32.7%), with MRSA predominating (41.9% vs. 14.9%) and Pseudomonas as the second commonest PWID pathogen (16.1%). Tricuspid valve involvement dominated in PWID (71%), while mitral valve predominated in non-PWID (55.4%). In-hospital mortality was 22.7% with no between-group difference (p = 0.787). Septicemia (OR 5.25), left-sided valve involvement (OR 5.59), deranged liver function (OR 3.76), and congestive heart failure (OR 3.41) independently predicted mortality; PWID status did not. Among 92 contactable patients at five-year follow-up, cumulative mortality was 56.5%, without significant between-group difference (p = 0.33).

Conclusions: IE in North India affects younger patients than Western cohorts. PWID-IE in North India shows distinct features including MRSA dominance and higher culture positivity, yet in-hospital and long-term mortality remain comparable between groups. High culture-negative rates and low surgical intervention warrant attention.

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印度北部感染性心内膜炎的演变谱和结果：注射吸毒者和不注射吸毒者之间的比较分析。

背景：来自南亚的感染性心内膜炎（IE）数据仍然有限，特别是在注射药物（PWID）患者中。印度北部面临着日益增长的注射药物负担，然而，PWID和非PWID人群之间的比较IE数据很少。方法：在印度旁遮普卢迪亚纳的一家三级中心进行回顾性队列研究，并进行前瞻性长期随访。在PWID组（n=62）和非PWID组（n=101）之间比较符合明确IE的修改Duke标准的患者（2017年1月- 2021年12月）。多变量logistic回归确定了住院死亡率预测因子。通过电话联系确定五年生命状况。结果：PWID患者较年轻（29.2±7.5岁∶45.0±15.4岁，p=0.001），以男性为主（98.4%∶64.4%），合并丙型肝炎感染率较高（54.8%∶5.9%）。PWID的血培养阳性较高（74.2%对32.7%），其中MRSA占主导地位（41.9%对14.9%），假单胞菌是第二常见的PWID病原体（16.1%）。PWID以三尖瓣受累为主（71%），而非PWID以二尖瓣受累为主（55.4%）。住院死亡率为22.7%，组间无差异（p=0.787）。败血症（OR 5.25）、左侧瓣膜受累（OR 5.59）、肝功能紊乱（OR 3.76）和充血性心力衰竭（OR 3.41）独立预测死亡率；PWID状态没有。随访5年，92例接触者累计死亡率为56.5%，组间差异无统计学意义（p=0.33）。结论：印度北部的IE患者比西方患者更年轻。印度北部的PWID-IE表现出明显的特征，包括MRSA优势和较高的培养阳性，但两组之间的住院死亡率和长期死亡率仍然具有可比性。高培养阴性率和低手术干预值得注意。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Indian heart journal CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

2.60

自引率

6.70%

发文量

审稿时长

52 days

期刊介绍： Indian Heart Journal (IHJ) is the official peer-reviewed open access journal of Cardiological Society of India and accepts articles for publication from across the globe. The journal aims to promote high quality research and serve as a platform for dissemination of scientific information in cardiology with particular focus on South Asia. The journal aims to publish cutting edge research in the field of clinical as well as non-clinical cardiology - including cardiovascular medicine and surgery. Some of the topics covered are Heart Failure, Coronary Artery Disease, Hypertension, Interventional Cardiology, Cardiac Surgery, Valvular Heart Disease, Pulmonary Hypertension and Infective Endocarditis. IHJ open access invites original research articles, research briefs, perspective, case reports, case vignette, cardiovascular images, cardiovascular graphics, research letters, correspondence, reader forum, and interesting photographs, for publication. IHJ open access also publishes theme-based special issues and abstracts of papers presented at the annual conference of the Cardiological Society of India.