Clinical features and outcomes of infective endocarditis in persons experiencing homelessness
Abstract Background Infective endocarditis (IE) is associated with significant morbidity and mortality and current treatment guidelines recommend a prolonged course of intravenous antibiotics. However, individuals experiencing homelessness face greater barriers to standard IE care. The aim of this s...
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BMC
2025-06-01
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| Series: | Infectious Diseases of Poverty |
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| Online Access: | https://doi.org/10.1186/s40249-025-01318-4 |
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| author | Torrance Teng Kyle Crooker Tess Hickey Max HoddWells Ashwini Sarathy Sean Muniz Jennifer Lor Amy Chang Bradley J. Tompkins Aaron O’Brien Elly Riser Devika Singh Jean Dejace Andrew J. Hale |
| author_facet | Torrance Teng Kyle Crooker Tess Hickey Max HoddWells Ashwini Sarathy Sean Muniz Jennifer Lor Amy Chang Bradley J. Tompkins Aaron O’Brien Elly Riser Devika Singh Jean Dejace Andrew J. Hale |
| author_sort | Torrance Teng |
| collection | DOAJ |
| description | Abstract Background Infective endocarditis (IE) is associated with significant morbidity and mortality and current treatment guidelines recommend a prolonged course of intravenous antibiotics. However, individuals experiencing homelessness face greater barriers to standard IE care. The aim of this study was to compare IE characteristics and outcomes in an unhoused population versus a housed population. Methods A retrospective cohort study encompassing 2010–2020 was conducted in Burlington, Vermont, comparing characteristics and outcomes of patients with IE who did or did not experience homelessness at the time of their infection. Primary outcomes included 30-day, 90-day, and 365-day mortality, IE-related mortality, and IE-related readmission rates. Secondary outcomes included rates of microbiologic failure and treatment failure. Results Of 378 included patients with IE, 30 (7.9%) experienced homelessness and 348 (92.1%) did not. The unhoused cohort was more likely to have right-sided IE involving the tricuspid valve (50.0% vs 21.6%, P = 0.006) and for the causative organism to be methicillin-resistant Staphylococcus aureus (MRSA) [9 (30.0%) vs 43 (12.4%), P = 0.039]. Mortality, IE-related mortality, and IE-related readmission rates were not significantly different between groups at any time point measured. For secondary outcomes, differences in microbiologic failure [5 (16.7%) vs 36 (10.3%), P = 0.543] and treatment failure [9 (30.0%) vs 105 (30.2%), P = 1.000] were also not statistically significant. Conclusions Future research should elucidate factors that entail increased risk of poor outcomes in this important underserved population and how to best mitigate them. |
| format | Article |
| id | doaj-art-a814f72f572f4be7b5ca5eb94b7bd89e |
| institution | DOAJ |
| issn | 2049-9957 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Infectious Diseases of Poverty |
| spelling | doaj-art-a814f72f572f4be7b5ca5eb94b7bd89e2025-08-20T03:21:06ZengBMCInfectious Diseases of Poverty2049-99572025-06-011411810.1186/s40249-025-01318-4Clinical features and outcomes of infective endocarditis in persons experiencing homelessnessTorrance Teng0Kyle Crooker1Tess Hickey2Max HoddWells3Ashwini Sarathy4Sean Muniz5Jennifer Lor6Amy Chang7Bradley J. Tompkins8Aaron O’Brien9Elly Riser10Devika Singh11Jean Dejace12Andrew J. Hale13Infectious Disease Unit, University of Vermont Medical CenterInfectious Disease Unit, University of Vermont Medical CenterInfectious Disease Unit, University of Vermont Medical CenterInfectious Disease Unit, University of Vermont Medical CenterInfectious Disease Unit, University of Vermont Medical CenterInfectious Disease Unit, University of Vermont Medical CenterInfectious Disease Unit, University of Vermont Medical CenterInfectious Disease Unit, University of Vermont Medical CenterInfectious Disease Unit, University of Vermont Medical CenterInfectious Disease Unit, University of Vermont Medical CenterInfectious Disease Unit, University of Vermont Medical CenterInfectious Disease Unit, University of Vermont Medical CenterInfectious Disease Unit, University of Vermont Medical CenterInfectious Disease Unit, University of Vermont Medical CenterAbstract Background Infective endocarditis (IE) is associated with significant morbidity and mortality and current treatment guidelines recommend a prolonged course of intravenous antibiotics. However, individuals experiencing homelessness face greater barriers to standard IE care. The aim of this study was to compare IE characteristics and outcomes in an unhoused population versus a housed population. Methods A retrospective cohort study encompassing 2010–2020 was conducted in Burlington, Vermont, comparing characteristics and outcomes of patients with IE who did or did not experience homelessness at the time of their infection. Primary outcomes included 30-day, 90-day, and 365-day mortality, IE-related mortality, and IE-related readmission rates. Secondary outcomes included rates of microbiologic failure and treatment failure. Results Of 378 included patients with IE, 30 (7.9%) experienced homelessness and 348 (92.1%) did not. The unhoused cohort was more likely to have right-sided IE involving the tricuspid valve (50.0% vs 21.6%, P = 0.006) and for the causative organism to be methicillin-resistant Staphylococcus aureus (MRSA) [9 (30.0%) vs 43 (12.4%), P = 0.039]. Mortality, IE-related mortality, and IE-related readmission rates were not significantly different between groups at any time point measured. For secondary outcomes, differences in microbiologic failure [5 (16.7%) vs 36 (10.3%), P = 0.543] and treatment failure [9 (30.0%) vs 105 (30.2%), P = 1.000] were also not statistically significant. Conclusions Future research should elucidate factors that entail increased risk of poor outcomes in this important underserved population and how to best mitigate them.https://doi.org/10.1186/s40249-025-01318-4EndocarditisHomelessnessUndomiciledUnderserved |
| spellingShingle | Torrance Teng Kyle Crooker Tess Hickey Max HoddWells Ashwini Sarathy Sean Muniz Jennifer Lor Amy Chang Bradley J. Tompkins Aaron O’Brien Elly Riser Devika Singh Jean Dejace Andrew J. Hale Clinical features and outcomes of infective endocarditis in persons experiencing homelessness Infectious Diseases of Poverty Endocarditis Homelessness Undomiciled Underserved |
| title | Clinical features and outcomes of infective endocarditis in persons experiencing homelessness |
| title_full | Clinical features and outcomes of infective endocarditis in persons experiencing homelessness |
| title_fullStr | Clinical features and outcomes of infective endocarditis in persons experiencing homelessness |
| title_full_unstemmed | Clinical features and outcomes of infective endocarditis in persons experiencing homelessness |
| title_short | Clinical features and outcomes of infective endocarditis in persons experiencing homelessness |
| title_sort | clinical features and outcomes of infective endocarditis in persons experiencing homelessness |
| topic | Endocarditis Homelessness Undomiciled Underserved |
| url | https://doi.org/10.1186/s40249-025-01318-4 |
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