To the Editor: We read the comprehensive review of infective endocarditis by Nohria, et al.,1 with great interest. The authors accurately detailed the clinical presentation and severe complications of endocarditis associated with injection drug use, including its disproportionate impact on younger patients and tendency to cause right-sided heart failure. However, from a patient safety perspective, a critical component of management was overlooked: treatment of the underlying substance use disorder.
Managing the infectious sequelae of injection drug use without addressing the addiction itself results in unacceptably high rates of treatment noncompletion, as well as reinfection and mortality. Acute hospitalization for infective endocarditis must be viewed as a pivotal opportunity. Evidence demonstrates that initiating medications for opioid use disorder such as buprenorphine or methadone during the first admission significantly increases the likelihood of patients completing antimicrobial therapy and reduces postdischarge mortality.2–4
The American Heart Association's scientific statement on management of infective endocarditis in people who inject drugs explicitly recommends a multidisciplinary approach that includes addiction medic ne consultation. Substance use disorder screening and the prompt initiation of medications for opioid use disorder are as fundamental to the care of patients with infective endocarditis as obtaining blood cultures and echocardiography.5
Family physicians are uniquely positioned for both postacute follow-up and chronic management of substance use disorder. We urge readers to view addiction treatment as an indispensable pillar in the management of injection drug use–associated endocarditis.
Editor’s Note: This letter was sent to the authors of “Infective Endocarditis: Diagnosis and Treatment,” who declined to reply.
