Top Things to Know: Infective Endocarditis in People Who Inject Drugs

Published: August 31, 2022

  1. The marked increase in infective endocarditis cases among persons who inject drugs over the past decade prompted the American Heart Association to develop a Scientific Statement that addresses the complex management issues of these patients.
  2. Multidisciplinary teams that include addiction-trained clinicians to address underlying substance use disorder can be organized to optimize patient outcomes.
  3. In individuals with injection drug use-associated infective endocarditis, the best management would include non-judgmental screening for unhealthy substance use, an immediate offering of Food and Drug Administration-approved medications for opioid use disorder (specifically buprenorphine or methadone) when indicated, and established treatments continued after hospitalization.
  4. Education to reduce the harms of injection drug use with screening and treatment for common sequalae of injection drug use, may be offered to persons who inject drugs with infective endocarditis.
  5. Persons who inject drugs with infective endocarditis may be eligible for a peripherally inserted central catheter and outpatient parenteral antibiotic therapy in some circumstances.
  6. In persons who inject drugs who are unable to complete six weeks of intravenous antibiotics for injection drug use associated infective endocarditis, providers may consider either oral antibiotics or long acting lipoglycopeptides to finish an antibiotic course under certain circumstances depending on the virulence of the specific pathogen, the degree of altered valvular anatomy and dysfunction, and after discussion with members of the Endocarditis Team.
  7. In cases when patient-directed discharge is imminent, infectious diseases, addiction medicine, and cardiac surgery (if applicable), it is reasonable for follow up to be offered along with providing oral antibiotics or long-acting lipoglycopeptides and medications to treat opioid use disorder.
  8. Cardiac valve surgery for persons who inject drugs with infective endocarditis may be considered in accordance with general recommendations for infective endocarditis that is not related to injection drug use.
  9. Cardiac valve repair rather than replacement is reasonable in the setting of injection drug use associated infective endocarditis whenever possible.
  10. Tricuspid valve vegetation removal by transcatheter aspiration technique may be an option in persons who inject drugs with infective endocarditis.


Baddour LM, Weimer MB, Wurcel AG, McElhinney DB, Marks LR, Fanucchi LC, Garrigos ZE, Pettersson GB, DeSimone DC; on behalf of the American Heart Association Rheumatic Fever, Endocarditis and Kawasaki Disease Committee of the Council on Lifelong Congenital Heart Disease and Heart Health in the Young; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; and Council on Peripheral Vascular Disease. Management of infective endocarditis in people who inject drugs: a scientific statement from the American Heart Association [published online ahead of print August 31, 2022]. Circulation. doi: 10.1161/CIR.0000000000001090