Infectious endocarditis (IE) is a growing health concern, with increasing incidence in the context of the opioid epidemic. We described a registry of patients with IE at an urban, academic safety-net hospital.

To identify neurological complications of infective endocarditis.

Between November 2017 and May 2019, 98 consecutive patients (mean 41.2 years; aged 20-82 years; 46% male) with IE were admitted to our center. Patients had a history of IVDU in 74% of cases. 37 unique microbes were isolated, most commonly Staphylococcus species (33 MSSA, 22 MRSA, 10 other). Polymicrobial infection occurred in 33 patients. On echocardiogram, vegetations were seen on tricuspid (48), mitral (49), aortic (18), and pulmonic (2) valves. 10 patients had multi-valve involvement. 58 patients had brain imaging. 6 out of 25 non-IVDU patients had neurological complications. 18 out of 73 IVDU patients had neurological complications. In IVDU patients- 17 cerebral infarctions, 7 intracranial hemorrhage (ICH),  2 brain abscesses, 2 mycotic aneurysms, 3 other. In non-IVDU patients- 3 cerebral infarcts, 3 ICH, 1 transient ischemic attack, 1 brain abscess. In both groups, neurological complications occurred most frequently in the setting of mitral valve involvement and in those with staphylococcus infections. In the IVDU group, 5 tricuspid valve vegetations were associated with 5 cerebral infarcts.

Despite association with IVDU, left-sided cardiac valve vegetations were common. Tricuspid valve involvement was frequently associated with neurological complications. Mitral valve involvement and Staphylococcus were associated with increased risk for neurologic complications. There was no difference in rate of neurological complications in IVDU vs non-IVDU populations (24% vs 24.6%).