Managing Recurrent Endocarditis in Substance Use Disorder: The Role of Civil Commitment and Comprehensive Care.

Abstract

BACKGROUND The incidence of drug-induced infectious endocarditis is rapidly rising in the United States. Healthcare providers face different challenges in the management of infectious endocarditis in persons who inject drugs, including addiction relapse, non-compliance with treatment, and the associated social stigma. These factors collectively complicate the management of drug-induced endocarditis, requiring comprehensive strategies that address both the medical condition and the underlying substance use disorder, as well as socio-behavioral aspects of patient care. CASE REPORT We present a case of a 33-year-old woman diagnosed with opioid use disorder and a history of tricuspid valve replacement who was transferred from a local emergency room to a general hospital for septic shock secondary to recurrent drug-induced infectious endocarditis. Psychiatry was consulted on day 13 of the admission after the patient was deemed, "not to be a surgical candidate" for second cardiac valve surgery because of a history of non-compliance and a high risk of drug relapse. Throughout her 4-month inpatient hospitalization, she received multiple forms of voluntary and involuntary treatment. The psychiatry consultation/liaison service played a significant role in the patient's care. She successfully engaged in multiple modalities of treatment that led to undergoing a second heart valve surgery. CONCLUSIONS This case highlights the importance of a multidisciplinary approach in management of infectious endocarditis in persons who inject drugs. The use of a civil commitment can allow for the provision of substance use disorder treatment and optimal medical care to an individual who may have lost hope and have temporarily impaired mental faculties.