Trends in the Management of Infective Endocarditis for Patients Who Inject Drugs: A Survey of Healthcare Facilities in Tennessee.

Background: The current endocarditis management strategies among Tennessee healthcare facilities for people who inject drugs (PWID) were evaluated. Methods: This was a survey-based study of healthcare facilities that treat infective endocarditis in PWID within Tennessee. The primary outcome of the study was to describe current practice among facilities regarding the treatment of endocarditis in PWID, including approaches to addiction management, antimicrobial therapy, and cardiac surgery. Results: There were 17 facilities that responded to the survey but only 16 facilities completed the entire survey. Although 15 facilities (88%) responded that they evaluate patients for substance use disorders on admission, only 4 (24%) of those facilities offered addiction consultation service. Regarding antibiotic therapy, most facilities offered completion of intravenous antibiotic course inpatient or at a skilled nursing facility (94% and 75%, respectively). Other treatment options less commonly offered by facilities included: transition to oral antibiotics (56%), use of long-acting lipoglycopeptides (50%), and outpatient parenteral antibiotic therapy (25%). Of the 16 facilities that completed the survey, only 7 performed cardiac surgery and 6 performed catheter-based interventions. Conclusions: Although most facilities surveyed offered completion of antibiotic therapy either as inpatient or at a skill nursing facility, they were less likely to offer alternative options such as home infusion antibiotics, long-acting antibiotics, or oral antibiotic treatment for endocarditis. Most facilities screened for substance abuse on admission, but few provided addiction services. There may be an opportunity to enhance care for PWID through alternative antibiotic therapies and addiction services.