MOUD Associated With 89% Lower 30-Day Mortality Risk For Endocarditis In Injection Drug Users

People hospitalized for injection drug use-associated infective endocarditis (IE) who received medications for opioid use disorder (MOUD) had significantly lower mortality within 30 days after discharge than those who did not receive MOUD. Among 218 people treated at University of Kentucky Healthcare, 1.2% of those who received MOUD died within 30 days, compared with 8.2% of those who did not. After accounting for other factors that could affect mortality, MOUD initiation was associated with approximately 89% lower odds of death within 30 days.

People receiving MOUD were also more likely to complete their prescribed antibiotic treatment. About 81.1% of the MOUD group completed antibiotic therapy, compared with 63.3% of those who did not receive MOUD. They were also less likely to leave the hospital against medical advice, at 13.6% compared with 32.7%. Completing antibiotic therapy was independently associated with survival at both 30 and 90 days.

At 90 days after discharge, mortality was 4.1% among people who received MOUD and 14.3% among those who did not. However, after researchers adjusted for other differences between the groups, the association between MOUD and lower 90-day mortality was no longer statistically significant.

The study included people treated between September 2021 and March 2025 through a specialized University of Kentucky Healthcare team designed to coordinate care for people with injection drug use-associated IE. Individuals with active substance use or a history of injection drug use were offered consultation with an addiction medicine specialist and treatment options that included buprenorphine, methadone, or naltrexone. Researchers compared outcomes for 169 people who received MOUD with 49 who did not and adjusted the analysis for other health factors that could influence the results.

The findings suggest that incorporating OUD treatment into care for people hospitalized with injection drug use-associated IE may improve both addiction treatment and completion of the medical treatment needed for the infection. However, the study was observational, meaning it identified an association between MOUD and better outcomes but does not establish that MOUD itself caused the reduction in mortality.

These findings were presented in The Impact Of MOUD Initiation In Patients With Injection Drug Use-Associated Infective Endocarditis by Seth Losiewicz, Bennett Collis, Sami El-Dalati, Evan Hall, Chloe Cao, and colleagues. The study examined whether MOUD initiation was associated with mortality, readmission, and antibiotic treatment completion among people treated for injection drug use-associated infective endocarditis.

The full text of The Impact of MOUD Initiation in Patients With Injection Drug Use-Associated Infective Endocarditis on May 16, 2026, by Open Forum Infectious Diseases. A free copy is available (accessed August 12, 2026).

For more information, contact: Sami El-Dalati, M.D., Physician, Division of Infectious Diseases, Department of Internal Medicine, University of Kentucky Medical Center, 3101 Beaumont Centre Circle, Lexington, Kentucky 40513; Email: s.eldalati10@gmail.com; Website: https://ukhealthcare.uky.edu/doctors/sami-el-dalati