Electronic Thesis and Dissertation Repository

Thesis Format

Monograph

Degree

Master of Science

Program

Epidemiology and Biostatistics

Supervisor

Silverman, Michael

2nd Supervisor

Elton-Marshall, Tara

Co-Supervisor

Abstract

Background. The incidence of infective endocarditis is progressively rising among people who inject drugs.

Methods. A retrospective cohort study was conducted using data from electronic medical records to characterize important predictors that contribute to the recurrence of infective endocarditis and evaluate the associations of survival time and predictors of interest in the presence of competing risks among people who inject drugs. Multivariate logistic and survival regression analyses were carried out to identify factors associated with infective endocarditis recurrence and death.

Results. We identified a significant association between PICC line misuse and infective endocarditis recurrence (OR=2.62, P=0.005). In addition, survival analyses showed that PICC line misuse increased both the rate of infective endocarditis recurrence (SHR=2.60, P=0.001) and mortality (HR=3.00, P=0.01).

Conclusion. PICC line misuse was associated with infective endocarditis recurrence and mortality. Preventative health interventions to target this high-risk group of patients need to be developed.

Summary for Lay Audience

Infective endocarditis is a potentially fatal infectious disease that damages the chambers and structural integrity of the heart. The use of injection drugs has become a significant contributing factor for the occurrence and recurrence of infective endocarditis. Previous studies have demonstrated that infective endocarditis is responsible for mortality rates of up to 40% and recurrence rates of up to 32% among the population of people who inject drugs (PWID). Treatment of infective endocarditis often involves cardiac surgery to replace damaged cardiac valves. However, this form of treatment is problematic among PWID due to high infective endocarditis recurrence rates and lethality of recurrent infection of prosthetic valves. Current knowledge is limited regarding the recurrence of infective endocarditis among PWID. Therefore, it is important to further the understanding of the risk factors associated with the recurrence of infective endocarditis to help guide informed decision-making regarding cardiac surgery among PWID. A challenge faced when assessing key factors that influence the recurrence of infective endocarditis is the presence of competing risks, which impede the recurrence of infective endocarditis and may lead to false inferences regarding the overall survival of PWID. This thesis used data from electronic medical records from St. Joseph's Hospital and London Health Sciences Center to characterize risk factors that are associated with the recurrence of infective endocarditis, assess the probability of infective endocarditis recurrence with consideration for death as a competing risk, and evaluate the association between survival time and important risk factors among PWID. Through analysis of endocarditis recurrence, this thesis identified peripherally inserted central catheter line misuse as an important risk factor for increased (1) odds of the development of recurrence of infective endocarditis, (2) rate of infective endocarditis recurrence, and (3) risk of mortality among PWID. Furthermore, this thesis identified admission to the intensive care unit and cardiac surgery as additional risk factors for increased risk of mortality among PWID. The results of this thesis will have a significant impact on public health efforts in the prevention of infective endocarditis recurrence and aid clinicians in targeting prevention strategies towards patients who have misused their peripherally inserted central catheter.

Creative Commons License

Creative Commons Attribution-Noncommercial 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License

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