National Trends in Drug Use-Associated Infective Endocarditis Reveal Shift Toward Stimulants

Article Impact Level: HIGH
Data Quality: STRONG
Summary of  Clinical Infectious Diseases  https://doi.org/10.1093/cid/ciag607 
Dr. Paul J Christine et al.

Points

University of Colorado Anschutz researchers analyzed national hospitalization data identifying more than one hundred eighteen thousand cases of drug use associated infective endocarditis between 2016 and 2022.
National endocarditis hospitalizations peaked at approximately eighteen thousand seven hundred cases in 2020 before declining by eighteen percent to fifteen thousand three hundred cases in 2022.
Declining overall endocarditis hospitalizations were driven primarily by reduced opioid associated cases following expanded harm reduction services and access to medications for opioid use disorder.
Longitudinal tracking demonstrated that stimulant involved endocarditis increased nationwide from thirty seven percent of cases in 2016 to nearly forty seven percent in 2022.
Regional analysis revealed a fifty nine percent probability of stimulant involved endocarditis in the Pacific region compared to thirty four percent in New England highlighting treatment disparities.

Summary

This study evaluated national and regional epidemiological trends in drug use–associated infective endocarditis (DUA-IE) hospitalizations across the United States. Published in Clinical Infectious Diseases by researchers at the University of Colorado Anschutz, the investigation analyzed national hospitalization database records from 2016 through 2022. Given that DUA-IE frequently afflicts young adults in their 30s and carries high rates of morbidity and mortality, the research sought to determine whether expanded access to harm reduction services, medications for opioid use disorder, and shifting substance consumption habits influenced national hospitalization trajectories.

The longitudinal study identified more than 118,000 DUA-IE hospitalizations nationwide over the seven-year observation period. National DUA-IE hospitalizations peaked at approximately 18,700 cases in 2020 during the COVID-19 pandemic before decreasing by 18% to roughly 15,300 cases in 2022, driven predominantly by a reduction in opioid-associated cases. However, stimulant-involved cases (methamphetamine and cocaine, alone or co-involved with opioids) increased significantly nationwide, rising from 37% of DUA-IE hospitalizations in 2016 to nearly 47% in 2022. Marked geographic heterogeneity was observed, with the probability of stimulant involvement reaching 59% in the Pacific region compared to 34% in New England.

The authors conclude that while overall DUA-IE hospitalizations are declining due to decreasing opioid-associated cases, stimulant use has emerged as a major driver of infective endocarditis, particularly in the Western United States. The shift in drug use patterns and the lack of FDA-approved pharmacotherapies for stimulant use disorder highlight an urgent need for targeted hospital-based addiction interventions, expanded harm reduction strategies, and dedicated post-discharge care protocols for individuals who use stimulants.

Link to the article: https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciag607/8979432?login=false

References

Christine, P. J., Fabricant, S., Appa, A., & Kimmel, S. D. (2026). Changing national and regional trends in drug use-associated infective endocarditis from 2016 to 2022. Clinical Infectious Diseases, ciag607. https://doi.org/10.1093/cid/ciag607