{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T08:58:34Z","timestamp":1767603514979,"version":"3.48.0"},"reference-count":33,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T00:00:00Z","timestamp":1767571200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Medicine and Pharmacy Carol Davila"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>Drug use\u2013associated infective endocarditis (DUA-IE) is an increasingly important clinical problem that affects younger patients and poses substantial diagnostic, therapeutic, and surgical challenges. We conducted a retrospective cohort study of adults with definite infective endocarditis treated at a tertiary referral center between 2017 and 2022, comparing patients with DUA-IE to those with non\u2013drug use\u2013associated infective endocarditis. Of the 189 patients, 43 (22.8%) had DUA-IE. These patients were significantly younger and had higher rates of HIV and hepatitis C coinfections. Staphylococcus aureus was the predominant pathogen, and right-sided valve involvement was more frequent; however, left-sided disease predominated among patients requiring valve surgery. Compared with non-DUA-IE patients, those with DUA-IE had larger vegetations, higher inflammatory markers, more frequent complications(including sepsis, embolic events, and heart failure), higher rates of emergency surgical intervention, longer hospitalizations, and increased in-hospital mortality rates. In conclusion, DUA-IE represents a distinct and more aggressive form of infective endocarditis, characterized by severe infection, increased complication rates, and a substantial surgical burden despite the younger patient age, underscoring the need for integrated infectious disease, surgical, and addiction-focused care models for these patients.<\/jats:p>","DOI":"10.3390\/microorganisms14010111","type":"journal-article","created":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T08:40:53Z","timestamp":1767602453000},"page":"111","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Severity and Surgical Burden in Drug Use-Associated Infective Endocarditis: A Six-Year Cohort Study"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-8818-9539","authenticated-orcid":false,"given":"Corina-Ioana","family":"Anton","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, \u201cDr. Carol Davila\u201d Central Military Emergency University Hospital, 134 Calea Plevnei, 010242 Bucharest, Romania"},{"name":"Department of Medico-Surgical and Prophylactic Disciplines, Titu Maiorescu University, 040441 Bucharest, Romania"},{"name":"Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Bvd., 050474 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bogdan Mircea","family":"Petrescu","sequence":"additional","affiliation":[{"name":"Department of Clinical Psychiatry, \u201cDr. Carol Davila\u201d Central Military Emergency University Hospital, 134 Calea Plevnei, 010242 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4289-178X","authenticated-orcid":false,"given":"Cosmin Alexandru","family":"Buzil\u0103","sequence":"additional","affiliation":[{"name":"Cardiovascular Surgery Department, \u201cDr. Carol Davila\u201d Central Military Emergency University Hospital, 134 Calea Plevnei, 010242 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ion","family":"\u0218tefan","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, \u201cDr. Carol Davila\u201d Central Military Emergency University Hospital, 134 Calea Plevnei, 010242 Bucharest, Romania"},{"name":"Department of Medico-Surgical and Prophylactic Disciplines, Titu Maiorescu University, 040441 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2508-2551","authenticated-orcid":false,"given":"Cristian Sorin","family":"Sima","sequence":"additional","affiliation":[{"name":"Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Bvd., 050474 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adrian","family":"Streinu-Cercel","sequence":"additional","affiliation":[{"name":"Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Bvd., 050474 Bucharest, Romania"},{"name":"Department of Infectious Diseases I, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"National Institute for Infectious Diseases \u201cProf. Dr. Matei Bal\u015f\u201d, 1 Dr. Calistrat Grozovici Street, 021105 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.1093\/eurjpc\/zwab184","article-title":"Global magnitude and temporal trend of infective endocarditis, 1990\u20132019: Results from the Global Burden of Disease Study","volume":"29","author":"Yang","year":"2022","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1002\/jhm.12996","article-title":"Infective Endocarditis in People Who Inject Drugs: A Scoping Review of Clinical Guidelines","volume":"18","author":"Selitsky","year":"2023","journal-title":"J. Hosp. Med."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Scheggi, V., Del Pace, S., Ceschia, N., Vanni, F., Merilli, I., Sottili, E., Salcuni, L., Zoppetti, N., Alterini, B., and Cerillo, A. (2021). Infective Endocarditis in Intravenous Drug Abusers: Clinical Challenges Emerging from a Single-Centre Experience. BMC Infect. Dis., 21.","DOI":"10.1186\/s12879-021-06697-1"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1097\/HCO.0000000000001192","article-title":"Current Trends and Challenges in Infective Endocarditis","volume":"40","author":"Patel","year":"2025","journal-title":"Curr. Opin. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1615","DOI":"10.1016\/j.athoracsur.2020.03.047","article-title":"Efficacy of Primary Surgical versus Medical Intervention for Treatment of Left-Sided Infective Endocarditis","volume":"110","author":"Gatzoflias","year":"2020","journal-title":"Ann. Thorac. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"\u00d8stergaard, L., Smerup, M.H., Iversen, K., Jensen, A.D., Dahl, A., Chamat-Hedemand, S., Bruun, N.E., Butt, J.H., Bundgaard, H., and Torp-Pedersen, C. (2020). Differences in Mortality in Patients Undergoing Surgery for Infective Endocarditis According to Age and Valvular Surgery. BMC Infect. Dis., 20.","DOI":"10.1186\/s12879-020-05422-8"},{"key":"ref_7","unstructured":"(2023). Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically, 11th ed (Standard No. CLSI Standard M07)."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Varga, E., Somodi, S., Moln\u00e1r, M., Ujv\u00e1rosy, D., Ga\u00e1l, K., Vask\u00f3, A., Szab\u00f3, Z., B\u00e1cskay, I., Lekli, I., and F\u00e9s\u00fcs, A. (2025). Evaluation of the Diagnosis and Antibiotic Therapy of Sepsis in the Emergency Department: A Retrospective Observational Study. Biomedicines, 13.","DOI":"10.3390\/biomedicines13071566"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1186\/s12954-021-00581-6","article-title":"Acute pain and self-directed discharge among hospitalized patients with opioid-related diagnoses: A cohort study","volume":"18","author":"Compton","year":"2021","journal-title":"Harm. Reduct. J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1016\/j.athoracsur.2021.12.068","article-title":"Surgeons\u2019 Perspectives on Valve Surgery in People with Drug Use\u2013Associated Infective Endocarditis","volume":"116","author":"Wurcel","year":"2023","journal-title":"Ann. Thorac. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1111\/ajad.13000","article-title":"Impact of Medications for Opioid Use Disorder on Discharge Against Medical Advice Among People Who Inject Drugs Hospitalized for Infective Endocarditis","volume":"29","author":"Suzuki","year":"2020","journal-title":"Am. J. Addict."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1093\/cid\/ciz869","article-title":"Long-term Outcomes Are Poor in Intravenous Drug Users Following Infective Endocarditis, Even After Surgery","volume":"71","author":"Straw","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1097\/ADM.0000000000001107","article-title":"Injection of Methamphetamine Has Increased in Boston, Massachusetts: 5 Waves of Centers for Disease Control and Prevention State Surveillance Data","volume":"17","author":"Streck","year":"2023","journal-title":"J. Addict. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"110956","DOI":"10.1016\/j.drugalcdep.2023.110956","article-title":"Gender, sexual orientation identity, and initiation of amphetamine injecting among people who inject drugs: Examination of an expanding drug era in Montreal, Canada, 2011\u201319","volume":"251","author":"Minoyan","year":"2023","journal-title":"Drug Alcohol Depend."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e3661","DOI":"10.1093\/cid\/ciaa1346","article-title":"Long-term Infective Endocarditis Mortality Associated With Injection Opioid Use in the United States: A Modeling Study","volume":"73","author":"Barocas","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1016\/j.jacc.2020.11.062","article-title":"Prospective Cohort Study of Infective Endocarditis in People Who Inject Drugs","volume":"77","author":"Llopis","year":"2021","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"266","DOI":"10.18433\/jpps32891","article-title":"Evaluation of Clinical Outcomes of Intravenous Drug Use-Related Infective Endocarditis in Buprenorphine-Treated Patients","volume":"25","author":"Piechowski","year":"2022","journal-title":"J. Pharm. Pharm. Sci."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1016\/j.mcna.2018.03.001","article-title":"Inpatient Addiction Consult Service: Expertise for Hospitalized Patients with Complex Addiction Problems","volume":"102","author":"Weinstein","year":"2018","journal-title":"Med. Clin. N. Am."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1935","DOI":"10.1093\/cid\/ciy924","article-title":"Addiction Medicine Consultations Reduce Readmission Rates for Patients With Serious Infections From Opioid Use Disorder","volume":"68","author":"Marks","year":"2019","journal-title":"Clin. Infect. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1053\/j.semtcvs.2020.11.031","article-title":"Cardiac Surgeons\u2019 Treatment Approaches for Infective Endocarditis Based on Patients\u2019 Substance Use History","volume":"33","author":"Mszar","year":"2021","journal-title":"Semin. Thorac. Cardiovasc. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"ofaa069","DOI":"10.1093\/ofid\/ofaa069","article-title":"End-of-Therapy Echocardiography May Not Be Needed in All in Patients With Endocarditis","volume":"7","author":"Virk","year":"2020","journal-title":"Open Forum Infect. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"ofac047","DOI":"10.1093\/ofid\/ofac047","article-title":"Creation of a Multidisciplinary Drug Use Endocarditis Treatment (DUET) Team: Initial Patient Characteristics, Outcomes, and Future Directions","volume":"9","author":"Vyas","year":"2022","journal-title":"Open Forum Infect. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"948","DOI":"10.1186\/s13063-021-05919-w","article-title":"A cross-sectional survey of potential factors, motivations, and barriers influencing research participation and retention among people who use drugs in the rural USA","volume":"22","author":"Hetrick","year":"2021","journal-title":"Trials"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2127","DOI":"10.1111\/add.15393","article-title":"Effect of initiation of medications for opioid use disorder on hospitalization outcomes for endocarditis and osteomyelitis in a large private hospital system in the United States","volume":"116","author":"Young","year":"2021","journal-title":"Addiction"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1080\/00981389.2023.2278777","article-title":"Centering persons who use drugs: Addressing social determinants of health among patients hospitalized with substance use disorders","volume":"63","author":"Roberts","year":"2023","journal-title":"Soc. Work Health Care"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2134","DOI":"10.1093\/cid\/ciad073","article-title":"Patterns of Infectious Disease Associated With Injection Drug Use in Massachusetts","volume":"76","author":"Gonsalves","year":"2023","journal-title":"Clin. Infect. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1016\/j.jacc.2018.10.082","article-title":"Clinical outcomes of infective endocarditis in injection drug users","volume":"73","author":"Rudasill","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2442","DOI":"10.1111\/jocs.15570","article-title":"Stratification risk analysis in Operative management (STOP score) for drug-induced endocarditis","volume":"36","author":"Habertheuer","year":"2021","journal-title":"J. Card. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.amjms.2021.03.011","article-title":"Burden of Infective Endocarditis in Homeless Patients in the United States: A National Perspective","volume":"362","author":"Khan","year":"2021","journal-title":"Am. J. Med. Sci."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1186\/s13011-023-00568-5","article-title":"Investigating social deprivation and comorbid mental health diagnosis as predictors of treatment access among patients with an opioid use disorder using substance use services: A prospective cohort study","volume":"18","author":"Adams","year":"2023","journal-title":"Subst. Abuse Treat. Prev. Policy"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"ofaa074","DOI":"10.1093\/ofid\/ofaa074","article-title":"In-Hospital Illicit Drug Use and Patient-Directed Discharge: Barriers to Care for Patients With Injection-Related Infections","volume":"7","author":"Eaton","year":"2020","journal-title":"Open Forum Infect. Dis."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1111\/jrh.12605","article-title":"Rural-urban differences in hospitalizations for opioid use-associated infective endocarditis in Kentucky, 2016\u20132019","volume":"38","author":"Siddiqi","year":"2022","journal-title":"J. Rural Health"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"106394","DOI":"10.1016\/j.cct.2021.106394","article-title":"Design and methods of a multi-site randomized controlled trial of an integrated care model of long-acting injectable buprenorphine with infectious disease treatment among persons hospitalized with infections and opioid use disorder","volume":"105","author":"Seval","year":"2021","journal-title":"Contemp. Clin. Trials"}],"container-title":["Microorganisms"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-2607\/14\/1\/111\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T08:53:44Z","timestamp":1767603224000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-2607\/14\/1\/111"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,5]]},"references-count":33,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["microorganisms14010111"],"URL":"https:\/\/doi.org\/10.3390\/microorganisms14010111","relation":{},"ISSN":["2076-2607"],"issn-type":[{"value":"2076-2607","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,5]]}}}