buprenorphine and Endocarditis--Bacterial

Misuse of high-dose buprenorphine (HDB), mainly by injection, is responsible of frequent infectious adverse events.. This is a retrospective study of infectious complications occurring in patients using HDB by injection. Forty-two cases were identified (29 men and ten women) and the data were collected between March 1999 and December 2008.. The infectious complications included cutaneous infections (27 cases), endocarditis (nine cases), osteoarticular infections (four spondylodiscitis and one sacroiliitis), and a vascular embolism with decrease in visual acuity.. The results of HDB maintenance treatment must be improved, both from the point of view of substitution and to limit its misuse by intravenous route injection. Health professionals have to play an important role in drug addict patients' education and supervision, to prevent buprenorphine injection and related infectious complications.

Topics: Abscess; Adult; Bacterial Infections; Buprenorphine; Discitis; Dose-Response Relationship, Drug; Endocarditis, Bacterial; Female; Heroin Dependence; Humans; Injections, Intravenous; Injections, Subcutaneous; Male; Narcotic Antagonists; Retrospective Studies

Subutex (buprenophine) was approved by the Health Science Authority of Singapore for heroin detoxification in 2002. The number of heroin addicts has decreased in Singapore since the introduction of Subutex. However, Subutex abuse and its associated complications became arising medical problems. We report the management of a series of infective endocarditis cases secondary to Subutex abuse.. We identified 12 cases of infective endocarditis in former heroin addicts treated with Subutex from August 2005 to April 2006. All patients were interviewed by the research coordinator and prospectively followed-up for two years.. The treatment period of Subutex endocarditis was often prolonged with a mean hospitalisation stay of 48 days, with 3.8 days in the intensive care unit. Multiple medical complications were noted. Staphylococcus aureus septicaemia accounted for 92 percent of cases. Mortality rate was 42 percent. Failure rate of medical therapy alone was common. 25 percent underwent open heart valve surgery. All patients were subsidised. Mean hospitalisation expenses was S$31,218.. Subutex endocarditis causes significant morbidity and mortality. It imposes a heavy medical and financial burden to the patient and society. Multidisciplinary treatment involving cardiologists, infectious disease physicians, psychiatrists, surgeons, medical counsellors and social workers is required to manage these patients.

Topics: Adult; Buprenorphine; Endocarditis, Bacterial; Female; Heroin Dependence; Humans; Injections, Intravenous; Length of Stay; Male; Middle Aged; Narcotic Antagonists; Prospective Studies; Singapore

We report a 25-year-old Malay man with Subutex-related endocarditis, complicated by protein-losing enteropathy from severe tricuspid regurgitation and congestive heart failure. The intestinal protein loss was reversed with surgical valvular intervention. This case highlights the importance of recognising the rare association between protein-losing enteropathy and congestive heart failure in the setting of endocarditis.

Topics: Adult; Biopsy; Buprenorphine; Echocardiography, Doppler, Color; Echocardiography, Transesophageal; Endocarditis, Bacterial; Follow-Up Studies; Heart Failure; Heart Valve Prosthesis Implantation; Humans; Jejunum; Male; Mitral Valve Insufficiency; Narcotics; Postoperative Complications; Prosthesis Failure; Protein-Losing Enteropathies; Reoperation; Sepsis; Staphylococcal Infections; Substance Abuse, Intravenous; Surgical Wound Dehiscence; Tricuspid Valve Insufficiency

Since the Food and Drug Administration (FDA) approved the use of buprenorphine hydrochloride (Subutex) for the treatment of opiate dependence in 2002, there has been a global trend of its IV abuse which led to life-threatening medical complications such as infective endocarditis (IE), cardiac failure, and death.. First episode IE were identified in 14 patients (prevalence of 10.8%) among 130 IV buprenorphine abusers who presented to the National University Hospital, Singapore between 2004 to 2006. The variables that were examined in the present study included age, gender, ethnicities, duration of symptoms, types of valves, laboratory, microbiology, echocardiographic features, types of antibiotics given, duration of hospitalization, and the mortality rate.. While the majority of these patients presented predominantly with pleuropneumonic symptoms and had tricuspid-valve vegetations with Staphylococcus aureus being the commonest causative organism as reported in other IV drug abusers, pulmonary arterial hypertension (PHT) seemed peculiarly common (79%), and the mortality (21%) was higher in our patients compared to previously reported series (5-10%). Univariate linear regression revealed no relationship between PHT and the presence of septic pulmonary emboli (p =.284) and pulmonary embolism (p =.777).. PHT may contribute to morbidity and mortality amongst IV buprenorphine abusers. A high index of suspicion of PHT is required in treating IV buprenorphine abusers who presented with pleuropneumonic symptoms. The absence of a relationship between PHT and pulmonary embolism underscores the possibility of the contribution of buprenorphine to PHT, which have been demonstrated in a number of animal studies.

Topics: Adult; Buprenorphine; Endocarditis, Bacterial; Female; Hospital Mortality; Hospitals, University; Humans; Hypertension, Pulmonary; Linear Models; Male; Opioid-Related Disorders; Pulmonary Embolism; Retrospective Studies; Singapore; Staphylococcus aureus; Substance Abuse, Intravenous

Topics: Adult; Buprenorphine; Endocarditis, Bacterial; Female; Hospitalization; Humans; Incidence; Male; Middle Aged; Narcotics; Singapore; Substance Abuse, Intravenous

High-dose buprenorphine (HDB) treatment began in France in 1996 according to relatively unrestricted prescription rules. Continued heroin injection by patients on HDB maintenance treatment and even HDB injection remain underestimated and may lead to a variety of infectious diseases.. Description of infectious complications occurring in patients receiving HDB maintenance treatment.. Retrospective study of drug addicts receiving HDB maintenance treatment, injecting (or highly suspected of injecting) it, and hospitalized for infections (other than HIV or viral hepatitis) in the department of infectious and tropical diseases in Nancy University Hospital. Data collection covered 1998 through 2003.. We identified 21 case reports, 9 concerning infectious endocarditis, 8 cutaneous abscesses, 2 osteoarticular infections, 1 meningitis and 1 Candida retinitis. The sex-ratio was of 1 woman for 2 men, and the patients' mean age was 29.8 years. Globally 13 patients had systemic infections. Nine patients admitted having injected HDB (and no other drugs) (including the case of Candida retinitis), while in the other 12 cases, the patients continued injecting heroin as well. The role of misused HDB was strongly suspected in those 12 infections, but was not clearly confirmed. All patients recovered from the infections. The long-term psychosocial outcome remains unknown.. The cases analyzed illustrate the dual reality that HDB is often ineffective as a maintenance treatment, since some patients continue to inject heroin, and that its misuse can have infectious consequences. The results of HDB maintenance treatment substitution are mixed. The individual benefit/risk ratio must be improved. Networking is crucial, notably between physician and pharmacist, and the monitoring system must be reinforced.

Topics: Abscess; Adult; Analgesics, Opioid; Buprenorphine; Dose-Response Relationship, Drug; Endocarditis, Bacterial; Female; Heroin Dependence; Humans; Male; Meningitis; Osteomyelitis; Retinitis; Retrospective Studies; Skin Diseases; Substance Abuse, Intravenous

Topics: Adult; Buprenorphine; Endocarditis, Bacterial; Gram-Positive Bacterial Infections; Gram-Positive Cocci; Humans; Male; Substance Abuse, Intravenous