Essay on The Dilemma Of Devising A Policy

1693 Words Jul 27th, 2015 7 Pages
Final Paper
The Dilemma of Devising a Policy for “Redo” Valvuloplasties in Recurrent Bacterial Endocarditis in Relapsing Intravenous Drug Users There has been an increasing incidence of intravenous (IV) heroin usage and overdoses in Ohio over the past 15 years. With it, hospitals in the state are seeing a substantial influx of medical complications related to IV heroin abuse. Infective endocarditis (IE) is one of the most severe, potentially life-threatening, complications for IV drug abuse with an inpatient mortality of 15-20% and a 1-year mortality of approximately 40%.1Once the bacteria infect the blood, they can adhere to cardiac structures creating infectious erosive masses which can lead to valvular insufficiency, stroke-causing embolic events, heart failure, and even sudden death. Successful treatment is dependent upon eradication of the causative microorganism, which requires prolonged intravenous antibiotic treatment and even surgery which involves valvular repair or replacement with a prosthesis (valvuloplasty) as the only definitive therapy.2
Previously, the incidence of IE in IV drug abusers is 2% to 5% per year, being responsible for 5% to 20% of IE-related hospital admissions. However, recent estimates in Ohio suggest that this number is disproportionately rising. Many IV drug abusers often develop recurrent IE infecting their already implanted prosthetics which can be more severe than the prior and necessitate reoperation – oftentimes on an urgent…

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