A Systematic Review of the Association between Individual Drugs Injected Intravenously and the Development of Infective Endocarditis

Issues: Infective endocarditis (IE) is a relatively rare disease that is associated with a significant amount of morbidity and mortality. Injection drug use associated IE is increasing in incidence, warranting a better understanding of how the drug of choice impacts the development of IE. Many studies have drawn connections between certain drugs injected intravenously and the development of IE but none have rigorously evaluated why a particular drug might predispose persons who inject drugs (PWID) to IE. Approach: The PubMed database was searched using a thorough search strategy. All human studies that reported on the drug(s) injected in patients who developed IE were analyzed and included. Key findings: No specific drug convincingly showed a strong association between its intravenous use and the development of IE, with studies having contradicting findings. The array of findings reported in the reviewed studies are more likely to be due to the frequency of use of particular drugs and their availability in the respective regions of study than the actual physiologic or pharmacologic properties of the drug. Implications: One trend that requires further investigation is the recent surge in opioid injection that has been linked to increased IE hospitalizations in several studies. Conclusion: Future research should aim to better understand how the preparation and/or physical properties of specific drugs may play a role in the development of IE.