Changing National and Regional Trends in Drug Use-Associated Infective Endocarditis From 2016 to 2022

BACKGROUND: Drug use-associated infective endocarditis (DUA-IE) is a life-threatening condition that has increased alongside opioid injection. Recent shifts in drug use patterns and access to harm reduction and addiction treatment necessitate updated national estimates to assess disease burden. METHODS: Using a representative sample of US hospitalizations from 2016 to 2022, we estimated national trends in DUA-IE hospitalizations among adults, stratified by year, drug category (opioids, stimulants, both, other), and census division. Logistic regression assessed the marginal probability of stimulant-associated endocarditis by individual (age, sex, race/ethnicity, insurance) and hospital characteristics (location/teaching status, bed size, census division). Analyses accounted for survey design and were weighted to provide national estimates. RESULTS: An estimated 118 190 DUA-IE hospitalizations occurred from 2016 to 2022, peaking in 2020 (n = 18 735) before declining annually through 2022 (n = 15 345). From 2016 to 2022, opioid-only hospitalizations decreased (49.4%-39.9%), while co-use of opioids and stimulants (22.6%-28.6%) and stimulant-only hospitalizations (14.7%-18.3%) increased. Regional trends varied, with stimulants surpassing opioids in several Western divisions. Logistic regression models showed rising probability of stimulant-involved DUA-IE, highest in Western divisions (Pacific: 0.59 [95% CI .56-.62] vs New England: 0.34 [95% CI .31-.38]). CONCLUSIONS: Drug use-associated infective endocarditis epidemiology is shifting, with overall hospitalizations declining but stimulant use emerging as a key driver, particularly in the Western United States. Current harm reduction and treatment efforts may be reducing DUA-IE hospitalizations, but targeted strategies addressing stimulant use are urgently needed.