Stimulants Play Growing Role in US Drug Use-Associated Endocarditis

US hospitalizations for drug use-associated infective endocarditis (DUA-IE) peaked in 2020 and declined through 2022, while the share involving stimulants grew, according to a study published online in Clinical Infectious Diseases.

Investigators used 2016 to 2022 data from the National Inpatient Sample, a representative sample of US hospitalizations, to estimate national DUA-IE trends among adults by year, drug category, and census division. The authors said recent shifts in drug use patterns and in access to harm reduction and addiction treatment warranted updated national estimates of disease burden.

The final sample of 23,638 hospitalizations represented an estimated 118,190 DUA-IE hospitalizations nationally after weighting. Annual hospitalizations rose from 13,350 in 2016 to 18,735 in 2020, then fell to 15,345 in 2022. Over the study period, opioid-only hospitalizations declined from 49.4% to 39.9% of the total, while co-use of opioids and stimulants increased from 22.6% to 28.6% and stimulant-only hospitalizations increased from 14.7% to 18.3%. Opioids nevertheless remained the most common drug type involved.

Regional patterns varied. By 2022, stimulant-only use equaled or surpassed every other drug category in the West South Central, Mountain, and Pacific divisions. In adjusted models, the probability that a hospitalization involved any stimulant was highest in the Pacific division and lowest in New England. Older age was associated with stimulant-only DUA-IE, and non-Hispanic Black and Asian individuals had higher probabilities of stimulant-involved hospitalizations. Overall, 7.6% of hospitalizations ended in in-hospital death and 27.1% in self-directed discharge.

The authors noted that diagnostic codes may misattribute drug use, that a single infection could be counted across multiple admissions, and that the data could not account for regional drug supply or local harm reduction and addiction services. They concluded that stimulant use is emerging as a key driver of DUA-IE, particularly in the Western US, and that targeted strategies addressing stimulant use are urgently needed.

Source: Christine PJ, Fabricant S, Appa A, Kimmel SD. Changing national and regional trends in drug use-associated infective endocarditis from 2016 to 2022. Clin Infect Dis. Published online October 27, 2026. doi:10.1093/cid/ciag607