Contemporary Trends and Outcomes of Infective Endocarditis Associated With Substance Use Disorders: A Nationwide Analysis.

BACKGROUND: Infective endocarditis (IE) is a serious complication linked to substance use disorders (SUDs). There is a paucity of data on the contemporary trends of IE hospitalizations specifically since the rise in opioid use during the COVID-19 pandemic. METHODS: We identified hospitalizations with any IE diagnosis from the Vizient Clinical Data Base from 2016 to 2023. We examined trends of IE hospitalizations among patients with and without SUD. A multivariable logistic regression was used to assess variables associated with in-hospital mortality among patients with IE. RESULTS: Among 120 142 patients hospitalized with IE, 26349 (21.9%) had an SUD diagnosis. Patients with IE associated with SUD were younger, predominantly White individuals, and primarily Medicaid enrollees. IE hospitalizations modestly declined in the SUD group (19.6% of hospitalizations in 2016 versus 16.2% of hospitalizations in 2023) but increased among the non-SUD group (80.4% of hospitalizations in 2016 versus 83.8% of hospitalizations in 2023). The in-hospital mortality rate was lower among patients with SUD compared with the non-SUD group (9.8% versus 14.1%; odds ratio, 0.79 [95% CI, 0.75-0.84]). The following factors were independently associated with in-hospital mortality: older age (odds ratio, 1.018 [95% CI, 1.016-1.019]), fungemia (odds ratio, 2.39 [95% CI, 2.14-2.66]), and hemodialysis (odds ratio, 3.60 [95% CI, 3.43-3.78]). CONCLUSIONS: This contemporary observational analysis highlights the ongoing burden of IE associated with SUD in the United States. Young adults and women were primarily affected. Future research should explore the drivers of these trends.