Pseudomonas aeruginosa endocarditis in drug addicts

Abstract

Six intravenous heroin users with P. endocarditis were seen between 1970 and 1972. Five out of six (83 per cent) had tricuspid valvulitis. Fever and a significant murmur were found in all cases, a subacute presentation and splenomegaly were found in 83 per cent, and chest pain with cavitating infiltrates on x-ray was observed in 67 per cent. Three patients died of infection. Three patients survived; one was cured with medical therapy alone, and two required surgical removal of the infected valve as well. The success of surgical ablation of the tricuspid valve in these patients is encouraging, particularly in view of their poor response before surgery to combinations of antibiotics with proved in vitro efficacy. Prior bacteremia with more virulent organisms may be important in the pathogenesis of endocarditis with Pseudomonas.