Infective endocarditis in intravenous drug users

Since its first documented case in 1646, the epidemiology of endocarditis has significantly evolved. In the modern era, endocarditis has been increasingly associated with invasive procedures, medical devices, and intravenous drug use (IVDU). Patients at greatest risk include those with immunosuppression due to diabetes mellitus, human immunodeficiency virus (HIV), transplant medications, and increased survival of those with congenital heart or prosthetic heart valves. Prevalence of this disease has also significantly evolved due to technology in detection and prophylaxis. We aim to provide a comprehensive review of injection IVDU epidemiology, mechanism, medical and surgical treatment, ethical dilemmas involved in the treatment of this high-risk population, and future directions in the management of this lethal disease. (C) 2019 Elsevier Inc. All rights reserved.