Abstract Body: Background: Infective endocarditis (IE) is a serious complication linked to substance use disorders (SUD). This study aimed to examine the contemporary nationwide trends and outcomes of IE hospitalizations among individuals with SUD.

Methods: We identified hospitalizations with any IE diagnosis from the Vizient^® Clinical Data Base between 2016-2023, data used with permission of Vizient, Inc. (All rights reserved). We examined IE trends in SUD vs. non-SUD individuals and used Cochrane-Armitage Test to analyze significance. Multivariable logistic regression was used to assess variables associated with in-hospital mortality among individuals with IE.

Results: Among 159,045 individuals hospitalized with IE, 37,596 (23.6%) had a history of SUD. Individuals with IE associated SUD vs. non-SUD were younger (39 vs. 63 years), predominantly White (77.3%), and primarily on Medicaid (66.5%). Staphylococcus species caused 53.2% of IE associated SUD hospitalizations. IE-SUD hospitalizations rose from 58.8 per 100,000 in 2016 vs 70.7 per 100,000 in 2022, then declined to 56.7 in 2023, P<0.001. Non-SUD hospitalizations for IE increased from 233.9 per 100,000 in 2016 vs 262.9 per 100,000 in 2023, P<0.001(Figure). In-hospital mortality was lower in the IE-SUD group vs. IE non-SUD group (8.6% vs 12.8%, P<0.001). The following factors were independently associated with in-hospital mortality: older age (OR 1.016, 95% CI 1.015–1.018), fungemia (OR 2.43, 95% CI 2.20–2.68), and hemodialysis (OR 3.44, 95% CI 3.29–3.59).

Conclusion: This contemporary nationwide observational analysis highlights the evolving national trends and outcomes of IE associated with SUD. Future research should explore the drivers of these trends to guide policy, with a focus on enhanced screening and preventative measures.