“It Eats My Heart”: Identifying Knowledge Gaps in Injection Drug-Related Endocarditis Among Hospitalized Patients

Abstract

Background:

Infective endocarditis (IE) rates have risen sharply, spurred by injection drug use (IDU). Public health interventions to prevent infectious complications of IDU have primarily focused on communicable diseases, such as HIV and viral hepatitis. We assessed patients’ knowledge of IE in relation to IDU practice.

Methods:

From 2021 to 2022, we conducted in-person semi-structured interviews (SSIs) with 16 adults hospitalized with IDU-related IE at an academic medical center in North Carolina. SSIs explored participants’ knowledge and experience of IE and IDU practices. The SSIs were audio-recorded, transcribed verbatim, and thematically coded.

Results:

We identified 4 primary themes: limited knowledge of IE; nonspecific IE symptoms; injection behavior and infection prevention; and knowledge of other IDU-related infections, such as hepatitis C virus (HCV) and HIV. Most patients reported little or no knowledge of IE before hospitalization despite previously having soft tissue infections, such as skin abscesses. Presentations were heterogeneous, with many patients not recognizing their symptoms as IE, and often delaying seeking care. In contrast to limited information about IE, all patients reported prior testing for HIV and HCV. While many expressed the importance of not reusing injection equipment, many patients reported reusing injection equipment nonetheless, and several specifically reported that they take no dedicated precautions to prevent infections.

Conclusion:

Our findings suggest prior to hospitalizations, knowledge of IE, its symptoms, and prevention is limited among persons who inject drugs who acquire IE. Our study indicates an urgent need to disseminate public health messages regarding preventing IDU-related invasive bacterial infections and providing access to sterile equipment to prevent bacterial infections.