Search Results (540)

Invasive infections caused by rare moulds (RM) are increasingly reported and often exhibit resistance to antifungal agents. Their epidemiology varies regionally, yet data from Greece are scarce. To address this gap, we conducted a 15-year retrospective study of RM fungaemia at a tertiary academic hospital in Athens, Greece. All microbiologically confirmed cases in hospitalised patients between 2010 and 2024 were reviewed. Demographic and clinical data were retrieved from medical records. Incidence rates were calculated per 1000 admissions and 10,000 bed-days. Isolates were morphologically identified and, when available, molecularly characterised and tested for antifungal susceptibility according to EUCAST guidelines. Eight RM fungaemia episodes (0.8% of total fungaemias) were identified, with an incidence of 0.01/1000 admissions and 0.03/10,000 bed-days, without bacterial co-infections. Haematological malignancies (62%) were the most common underlying condition. Fusarium spp. were the predominant pathogens (6/8), followed by single cases due to Lomentospora prolificans and Acremonium spp. Amphotericin B showed the highest in vitro activity against Fusarium isolates (MIC 0.5–1 mg/L), followed by voriconazole (MICs 2–8 mg/L) whereas other azoles showed no in vitro activity (MICs ≥ 8 mg/L). Half of the infections were breakthrough, whereas in 3/8 cases, the diagnosis was established post-mortem (n = 2) or post-discharge. Among the five patients who received treatment, the crude mortality rate was 60%. This first epidemiological report on RM fungaemia in Greece highlights the predominance of Fusarium spp., the frequency of breakthrough infections, and the challenges in early diagnosis and management. Increased clinical awareness and regional surveillance are essential for optimising outcomes. Full article

Objectives: Atrial fibrillation (AF) is associated with high risk of ischaemic stroke (IS). Oral anticoagulant therapy (OAT) is the standard of care for stroke prevention, even though its management remains challenging in clinical practice. An emerging problem is embolic events occurring on adequately conducted OAT, the so-called resistant stroke (RS). We aimed to describe pre-stroke prevention therapy, management on hospital discharge, and therapy at follow-up in all patients with AF hospitalized for IS and in the RS subgroup. Methods: We conducted a retrospective monocentric study of patients with known AF hospitalized for an IS. A subgroup with RS was identified. We recorded information on prevention therapy at home, recommended therapy at discharge, and data on outcome and prevention therapy at follow-up. Results: We identified 226 patients, 61% females, median age 84.04 years. Preventive therapy at home was performed in 121 (53.5%) (119 OAT and 2 Left Atrial Appendage Occlusion). At hospital discharge OAT was prescribed to 78.2% of patients. RS was diagnosed in 33 patients whose management at discharge was: same OAT in 12, shift to another Direct Oral Anticoauglant (DOAC) in 5, from DOAC to Vitamin K Antagonist (VKA) and vice versa in 11, non-specified OAT in 4. At final, follow-up of 208 days (range 85–443) 23.3% (34/146) did not assume OAT. OAT was significantly associated with survival probability (p < 0.001). Conclusions: Our findings confirm a scarce adoption of guidelines for AF-related embolic events, even in the absence of absolute contraindication to OAT. RS remains an underexplored clinical entity with empirical management, highlighting the need for targeted research and tailored therapeutic strategies. Full article

Background: Anemia is a common comorbidity in heart failure (HF) and has been associated with adverse clinical consequences. This retrospective, descriptive cohort study examined phenotype-specific differences in anemia severity, clinical presentation, comorbid burden, and in-hospital management across HF subtypes classified by left ventricular ejection fraction (LVEF). Methods: We retrospectively analyzed 443 adult patients hospitalized with concurrent HF and anemia from January 2022 to December 2024. Patients were stratified by LVEF into HFrEF (<40%), HFmrEF (40–49%), and HFpEF (≥50%). All patients included met WHO criteria for anemia. Demographic, clinical, paraclinical, and therapeutic data were extracted, and descriptive statistical methods were used to evaluate intergroup differences. No formal time-to-event analyses (e.g., Kaplan–Meier curves) were performed; instead, exploratory cumulative readmission analyses using fixed follow-up windows were conducted. In-hospital mortality was recorded and stratified by HF phenotype. Results: The cohort comprised 213 (48.0%) HFrEF, 118 (26.6%) HFmrEF, and 112 (25.3%) HFpEF patients. The distribution of anemia severity, management strategies, and comorbidity profiles varied significantly across phenotypes. Severe anemia predominated in the HFmrEF cohort (54.2%), whereas mild anemia was most common in HFpEF (52.1%) and HFrEF (52.1%). Mean hemoglobin concentrations were 8.39 ± 1.79 g/dL (HFmrEF), 9.07 ± 2.47 g/dL (HFpEF), and 8.62 ± 1.94 g/dL (HFrEF). Rates of atrial fibrillation (48.2% in HFpEF), hypertensive ECG changes (63.4% in HFpEF), and ischemic-lesion patterns (>50% in HFrEF) differed by cohort. Echocardiographically, grade III mitral regurgitation and severe pulmonary hypertension each affected 25.4% of HFmrEF patients, whereas HFpEF patients most often exhibited grade II mitral regurgitation (42.9%) and moderate pulmonary hypertension (42.9%). HFrEF patients had severe pulmonary hypertension. Intravenous (IV) iron was the primary treatment modality, with highest utilization in HFmrEF. IV iron use ranged from 69.9% (HFrEF) to 84.8% (HFmrEF), with transfusion rates of 5.6% (HFrEF)–16.1% (HFpEF). Comorbid burdens differed by phenotype: HFrEF was associated with structural heart disease, HFmrEF with vascular and hepatic pathology, and HFpEF with metabolic and degenerative comorbidities. Discharge pharmacotherapy reflected phenotype-specific treatment patterns. Conclusions: This real-world descriptive analysis highlights substantial variation in anemia burden and management across the HF spectrum. While limited to descriptive findings, our analysis highlights the heterogeneity of anemia in HF and describes observed associations across phenotypes, without implying causality. These findings should be interpreted as hypothesis-generating. These findings are observational, exploratory, and cannot establish a causal relationship between intravenous iron use and survival. Full article

Background: Malnutrition contributes to frailty dementia, intensifying adverse health outcomes including mortality risk. Objectives: We aim to investigate the impact of malnutrition risk in those with frailty and functional decline on short-term mortality among older adults with dementia and/or cognitive impairment. Methods: We conducted a retrospective cohort study involving 2677 hospitalized patients aged ≥65 years with a diagnosis of dementia or cognitive impairment discharged between March 2022 and December 2023. Information was obtained from electronic medical records. Frailty was assessed using the Clinical Frailty Scale (CFS) and Hospital Frailty Risk Score (HFRS), functional status using premorbid activity of daily living (ADL) scores, and malnutritional risk using the 3-Minute Nutrition Screening (3-Min NS) tool. Associations with 30- and 90-day mortality were examined using Kaplan–Meier analysis and multivariate logistic regression models. Results: A total of 29.2% were at risk of malnutrition, highest in the old-old (37.1%). Thirty-day mortality was significantly associated with CFS (aOR = 1.498, 95% CI: 1.349–1.664, p < 0.001), HFRS (aOR = 1.020, 95% CI: 1.001–1.040, p = 0.038), and ADL (aOR = 0.819, 95% CI: 0.753–0.890, p < 0.001). Malnutrition risk demonstrated the strongest association across all models (ADL: aOR = 2.573, 95% CI: 1.922–3.443, p < 0.001; CFS: aOR = 2.348, 95% CI: 1.738–3.156, p < 0.001; HFRS: aOR = 2.944, 95% CI: 2.210–3.922, p < 0.001). Associations between 90-day mortality and malnutrition risk remained significant across all models, including those adjusted for CFS and ADL. Notably, interactions between malnutrition and CFS further amplified mortality risk among the old-old (30-day: aOR = 1.435, 95% CI: 1.082–1.902, p = 0.012; 90-day: aOR = 1.263, 95% CI: 1.005–1.588, p = 0.045). Conclusions: Risk of malnutrition independently predicted short-term mortality in older adults with dementia or cognitive impairment, particularly among those with frailty, functional decline, and of advanced age. Full article

Purpose: To evaluate the prevalence of undiagnosed ligamentous knee injuries in patients surgically treated for high-energy pelvic ring or acetabular fractures and propose a mechanism to diagnose these briefly post-hospital discharge. Methods: A retrospective case series (level of evidence IV) was conducted at Italy’s largest trauma center. Medical records from 2018 to 2023 were reviewed to identify patients who underwent surgical treatment for pelvic or acetabular fractures. Eligible patients were contacted for a structured telephone interview, which included a questionnaire on knee symptoms and the International Knee Documentation Committee (IKDC) score. Associations between demographic factors, trauma mechanism, and knee outcomes were statistically analyzed. Results: Fifty-nine patients (mean age 55 years, 72.9% male) were enrolled. Undiagnosed knee ligament injuries were present in 11.9%, with an additional 8.5% reporting persistent knee symptoms. The average time to diagnosis was 6.4 months post-discharge. Patients involved in road traffic accidents showed a significantly higher incidence of knee injuries (34.8%) compared to those who fell from a height (3.9%) (p = 0.049). Patients who had undergone ligament reconstruction had significantly lower IKDC scores (62.0 ± 8.2) than non-surgical cases (82.4 ± 12.1, p = 0.0002). No association was found with age or sex. Conclusions: Ligamentous knee injuries are frequently overlooked in the acute management of high-energy pelvic fractures, particularly in road traffic accidents. A systematic knee assessment before discharge or early outpatient imaging should be considered to improve detection and outcomes. Full article

Background: Pelvic fractures are complex injuries often associated with significant morbidity and mortality, requiring multidisciplinary management. This case series highlights the presentation, management strategies, and outcomes of patients with pelvic fractures treated at our institution. Methods: The medical records of 13 patients diagnosed with pelvic fractures from 1 January 2020 through 31 December 2023 were retrospectively reviewed. Demographic data, mechanism of injury, fracture pattern, associated injuries, treatment modalities, and outcomes were analyzed. Results: A total of 13 patients were included in the study, with ages ranging from 18–95 years. Six of the patients were male and seven were female. The most common mechanisms of injury were falls and pedestrians struck by vehicles. Associated injuries included traumatic brain injury (TBI), fractures including extremities, ribs, and vertebrae, visceral injury, and spinal cord injury. Treatment strategies ranged from conservative, non-surgical management to operative intervention, including interventional radiology embolization, external traction, open reduction and internal fixation (ORIF), and percutaneous screw stabilization. Additional interventions included chest tube placement, exploratory laparotomy, and craniectomy. Two patients died while in the hospital, one was discharged to a shelter, and the remaining 10 were discharged to various inpatient rehab facilities. Conclusions: Pelvic fractures pose significant clinical challenges due to their complexity and associated injuries. This case series underscores the importance of multidisciplinary intervention and treatment strategies in optimizing outcomes. Further studies should focus on the effectiveness of interventions, utilization of new technology, and multidisciplinary team planning. Full article

Background: COVID-19-associated coagulopathy (CAC) is a complex condition, with high rates of thrombosis, high levels of inflammation markers and hypercoagulation (increased levels of fibrinogen and D-Dimer), as well as extensive microthrombosis in the lungs and other organs of the deceased. It resembles, without being identical, other coagulation disorders such as sepsis-DIC (SIC/DIC), hemophagocyte syndrome (HPS) and thrombotic microangiopathy (TMA). Platelets (PLTs), key regulators of thrombosis, inflammation and immunity, are considered an important risk mediator in COVID-19 pathogenesis. Platelet index MPV/PLT ratio is reported in the literature as more specific in the prognosis of platelet-related systemic thrombogenicity. Studies of MPV/PLT ratio with regards to the severity of COVID-19 disease are limited, and there are no references regarding this ratio to the outcome of COVID-19 disease at specific time points of hospitalization. The aim of this study is to evaluate the relationship of COVID-19 mortality with the red cell distribution width–coefficient of variation (RDW-CV), platelets and MPV/PLT ratio parameters. Methods: Values of these parameters in 511 COVID-19 hospitalized patients were recorded (a) on admission, (b) as mean values of the 1st and 2nd week of hospitalization, (c) over the total duration of hospitalization, (d) as nadir and zenith values, and (e) at discharge. Results: As for mortality (survivors vs. deceased), statistical analysis with ROC curves showed that regarding the values of the parameters on admission, only the RDW-CV baseline was of prognostic value. Platelet parameters, absolute number and MPV/PLT ratio had predictive potential for the disease outcome only as 2nd week values. On the contrary, with regards to disease severity (mild/moderate versus severe/critical), only the MPV/PLT ratio on admission can be used for prognosis, and to a moderate degree. On multivariable logistic regression analysis, only the RDW-CV mean hospitalization value (RDW-CV mean) was an independent and prognostic variable for mortality. Regarding disease severity, the MPV/PLT ratio on admission and RDW-CV mean were independent and prognostic variables. Conclusions: RDW-CV, platelets and MPV/PLT ratio hematological parameters could be of predictive value for mortality and severity in COVID-19 disease, depending on the hospitalization timeline. Full article

Background/Objectives: Pulmonary embolism (PE) remains a major cause of morbidity and mortality. Despite advances in care, its nonspecific symptoms pose diagnostic and therapeutic challenges. Emerging evidence suggests sex-based differences in PE presentation, management, and outcomes, yet real-world data from European settings remain scarce. This study aimed to investigate sex differences in clinical presentation, diagnostic workup, therapeutic interventions, and outcomes among hospitalized PE patients. Methods: We conducted a retrospective cohort study including all adult patients (≥18 years) admitted with a main diagnosis of acute PE at the Cantonal Hospital Baselland between January 2018 and December 2020. Data were extracted from electronic medical records and included demographics, comorbidities, symptoms, diagnostics, treatments, and outcomes. Sex-based comparisons were performed using univariate analyses. Results: Among 197 patients, 54% were women. Compared to men, women were more often admitted by ambulance (42% n = 45 vs. 24% n = 22, p = 0.009), had more frequent tachycardia (38% n = 41 vs. 23% n = 21, p = 0.024), and received lysis therapy more often (10% n = 11 vs. 2% n = 2, p = 0.023). DVT was more frequently diagnosed in women when sonography was performed (82% n = 49 vs. 64% n = 34, p = 0.035). Men had higher rates of B symptoms, smoking, and family history of PE. Women had longer hospital stays and were more frequently discharged to rehabilitation facilities. No sex differences were found in in-hospital mortality, 6-month rehospitalization, or adherence to diagnostic guidelines. Conclusions: This study reveals sex-based differences in PE presentation and management, suggesting potential disparities in care pathways. Further research is needed to promote equitable, personalized treatment strategies. Full article

Pharmacist-led transitions of care (TOC) services decrease preventable hospital readmission. TOC service implementation assessment can inform translation to real-world settings. The purpose of this study was to evaluate the implementation of a TOC service for patients with multiple admissions at a regional hospital using the RE-AIM framework. In this quasi-experimental, non-randomized study, individuals with ≥2 recent hospitalizations received pharmacist-led discharge medication reconciliation and counseling, management of drug-related problems, post-discharge telephonic visits, and social support. The reach, effectiveness, implementation, and maintenance RE-AIM dimensions were assessed using patient and service records. Outcomes included 30-day readmission rates for individuals completing ≥1 outpatient pharmacist visit (intervention) versus those unreachable in the outpatient setting (comparison), completed interventions, implementation features, and service adaptations. Chi-square and Fisher’s exact tests were used for comparison of categorical variables and the t-test was used for continuous variables. From February 2022 to August 2023, 72.7% of the 66 service participants participated in the intervention (reach). Additionally, 30-day readmission was 22.9% (intervention) versus 55.6% (comparison; p = 0.01). In total, 2279 interventions were documented (effectiveness). The service was adapted (implementation) and expanded to include additional populations (maintenance) to enhance sustainability. Based on RE-AIM evaluation, the pharmacist-led TOC intervention appears to be a sustainable solution for addressing readmission in multivisit patients. Full article

Introduction: This study aimed to explore the clinical and psychosocial characteristics associated with functional non-remission in young adults involuntarily hospitalized for a first episode of psychosis (FEP), focusing on the role of duration of untreated psychosis (DUP) and contextual vulnerabilities. Material and method: We conducted a retrospective monocentric study including 123 patients aged 18–30 who were involuntarily admitted between 2013 and 2023 for a first psychotic episode. Sociodemographic, clinical, and care-related data were extracted from medical records. Functional remission was defined as a Global Assessment of Functioning (GAF) score ≥70 at discharge. Univariate and multivariate logistic regressions were used to identify predictors of functional non-remission. Results: Only 48.8% of patients achieved functional remission at discharge. Social isolation, low socioeconomic status, unemployment, lack of structured activities, and a DUP ≥ 4 weeks were significantly associated with functional non-remission. After multivariate logistic regressions, DUP ≥ 4 weeks remained an independent predictor of functional non-remission. Conclusions: Involuntary admission per se was not a direct predictor of poor outcome. Our findings highlight the critical role of prolonged DUP and psychosocial vulnerability in the trajectory of early psychosis. Early detection strategies, psychosocial support integration, and individualized care planning are essential to improve outcomes among young people experiencing FEP under compulsory admission. Full article

Background: Pleural empyema (PE) is a major cause of morbidity and mortality worldwide. This study aimed to analyze the epidemiological characteristics of patients hospitalized for PE in Spain between 2016 and 2022. Methods: This retrospective observational study of PE cases was based on the hospital discharge records from the National Health System between 2016 and 2022. The variables analyzed were sex, age, comorbidities, discharge diagnoses and procedures, overall severity, whether empyema was a primary or secondary diagnosis, admission to the intensive care unit (ICU), length of stay (LOS), in-hospital mortality, and healthcare costs. Results: Between 2016 and 2022, 19864 PE cases were diagnosed in Spain, revealing an overall rate of 0.64 per 1000 hospitalizations, with the exception of a slight decline in 2021. The mean age of the patients with PE was 61 years, and 73.85% were men. Most patients had low comorbidities, with a median Charlson comorbidity index (CCI) of 1.7. Most cases (63%) involved secondary diagnoses (pneumonia, pneumococcal pneumonia, sepsis, COVID, or lung cancer). The in-hospital mortality rate was higher in the secondary diagnosis group than in the primary diagnosis group (13.4% vs. 6.2%, respectively, p < 0.001). The factors associated with increased mortality included older age (≥66 years), higher CCI scores, ICU admission, and shorter LOS (<10 days). Conversely, pleural drainage and pneumonia as secondary diagnoses were protective factors. Conclusions: PE is an increasingly common pathology in clinical practice, especially in older and frail patients. It is associated with high morbidity and mortality, and its prognosis worsens with age and comorbidities. Therefore, early and appropriate diagnosis and standardized management strategies are required to mitigate the mortality and healthcare costs. Full article

Background: There is limited knowledge about nutritional intake and energy needs during the post-intensive care unit (ICU) period and their relationship with clinical outcomes and physical recovery. Aims and Methods: Thus, this observational multicenter study (Azienda Ospedaliero-Universitaria “Santa Maria”, Terni and “Madonna del Soccorso” General hospital, San Benedetto del Tronto, Italy) aimed, firstly, to measure energy expenditure via indirect calorimetry (IC) (Q-NRG+^® Metabolic Monitor, Cosmed, Rome, Italy), derived respiratory quotient (R/Q1) and, malnutrition risk via Mini Nutritional Assessment (MNA) test and body composition through bioimpedance vector analysis (BIVA-Akern, Pontassieve, Italy); secondly, to assess their effect on energy needs, body composition and physical rehabilitation steps in critically ill adults after ICU discharge. The provision of nutrients (PIS test) was also recorded. Oral nutritional supplementation was used to reach the optimal nutritional intake. All patients followed a standardized rehabilitation program. Results: A total of 43 patients were enrolled from January 2024 until February 2025 at the beginning of their post-ICU period. The mean age was 65.7 ± 1.0 years, the mean BMI was 20.73 ± 0.8 kg/m² at the recovery ward, and 60.4% (n = 26) were male. The mean admission period was 19.5 ± 1.7 days. The resting energy expenditure (mREE) was 1591 ± 71.2 at the admission and 1.856 ± 62.7 kcal/kg/d at the discharge (p < 0.05). The median phase angle value was 4.33 ± 0.15 at the admission and 5.05 ± 0.17° at the discharge (p < 0.05); R/Q1 at the admission was 0.7 ± 0.1 and 1.086± 0.11 at the discharge (p < 0.05). Improved energy expenditure significantly correlated with R/Q1 and phase angle (r = 0.81 and r = 0.72, respectively). Interestingly, there was no significant correlation between improved metabolism and improved PIS test scores (r = 0.18). Improved metabolism and nutritional status showed a tendency to correlate with shorter post-ICU courses and earlier physical recovery, without reaching statistical significance. Conclusions: Measurement of energy expenditure and caloric intake, along with the assessment of body composition is feasible and provides an objective tool to guide and possibly enhance the functional recovery in patients during the post-ICU period. Full article

Background/Objectives: The phase angle (PhA) is an emerging biomarker reflecting the cellular integrity and nutritional status. This study aimed to explore potential associations between the PhA, clinical severity scores, and 60-day survival outcomes following an admission to the Intensive Care Unit (ICU). Methods: This prospective, single-center study included 43 critically ill patients admitted to the ICU at Evangelismos General Hospital between May and November 2024. Patients were stratified by their PhA (≤5.4° vs. >5.4°). The PhA was measured at admission and subsequently on days 5–7, 10–11, 13–14, and until discharge. Severity scores (SOFA and APACHE II) were recorded. Between-group differences were assessed using independent samples t-tests and Mann–Whitney U tests, as appropriate. Survival was analyzed using Kaplan–Meier curves and Cox proportional hazards models. Results: The mean age was 54.6 ± 17 years; 63.6% were male. At ICU admission, patients with a PhA > 5.4° were significantly younger (p < 0.001) and had a higher fat-free mass (p < 0.001), greater calf circumference (p < 0.001), higher extracellular water (p < 0.001), larger mid-upper arm circumference (p = 0.009), and higher resting energy expenditure per kilogram (27.4 vs. 23.1 kcal/kg, p = 0.002). The PhA declined significantly during the ICU stay (p < 0.001). The Kaplan–Meier analysis showed a significantly shorter survival in patients with a PhA ≤ 5.4° (HR: 6.32, p = 0.019), which remained significant after adjusting for sepsis (p = 0.017). In a multivariable Cox regression, both PhA and APACHE II scores independently predicted mortality. Conclusions: While limited by a small sample size and single-center design, these findings support the further exploration of the PhA as a monitoring tool in critical care. Full article

Background/Objectives: Patients with New York Heart Association (NYHA) class III heart failure (HF) suffer from frequent hospitalizations. Non-invasive pulmonary artery pressure (PAP) sensor-guided HF care has been shown to reduce hospitalizations. However, it is unknown whether the PAP changes prior to hospitalization differ between clinical right, left or global cardiac decompensation. Methods: Sensor-derived PAP data and HF hospitalization records from 41 patients with NYHA class III HF were classified retrospectively into predominantly left, right or global decompensation. Linear mixed-effect regression models were used for statistical evaluations of the PAP in selected hospitalizations for which admission was at least 28 days after the last admission and 14 days after the last hospital discharge and with readings in between. Results: During 24.4 months of follow-up, 127 hospitalizations in 38 patients were evaluated. The global cardiac decompensation (n = 13) had the highest PAP before hospitalization, followed by left-sided (n = 20) decompensation. Patients with right-sided decompensation (n = 9) had comparable PAP values before hospitalization to the cohort without any cardiac decompensation (n = 85). The diastolic PAP showed a significant increase of 0.035 mmHg/day (p = 0.0097) in left-sided decompensation and of 0.13 mmHg/day (p < 0.0001) in global cardiac decompensation, whereas no significant change in the diastolic PAP occurred prior to the right-sided decompensation. The baseline right ventricular function and right ventricle–pulmonary arterial coupling (TAPSE/PASP ratio) were impaired in patients with subsequent global cardiac decompensation. Conclusion: PAP telemonitoring-guided therapy can reliably detect early signs of left and global cardiac decompensation but may be limited in detecting right-sided cardiac congestion. The routine assessment of RV–PA coupling may improve the detection of global cardiac decompensation, as severe impairments could indicate impending deterioration. In contrast, monitoring the RV contractility may aid in identifying isolated right-sided congestion and imminent decompensation. Full article

Background: Rising rates of opioid use disorder (OUD), usually via injection, has resulted in younger patients being diagnosed with infective endocarditis (IE), with unique treatment challenges. Methods: This retrospective ecological study analyzed hospital discharge and home health records from 2016 to 2022 in South Carolina (SC). Cases of IE with concurrent coding for OUD were identified. Differences in patient demographics, hospital characteristics, length of care days, and charges by OUD status were determined using chi-square or t-tests. IE hospitalization rates by OUD status, year, and age group were calculated, and linear regression was used to determine differences by year. Results: There were 8601 acute-care hospitalization records for IE from 2016 to 2022 in the SC dataset, of which 1180 (13.7%) had concurrent OUD coding. Statistically significant differences between patients with and without OUD were identified for sex, age group, race, resident rurality, average number of comorbidities, disposition status, and year (all p < 0.01). The incidence rate of IE increased from 2.5/100,000 in 2016 to 6.9/100,000 in 2022 in patients aged 36 to 49 years with OUD (p = 0.02). Patients with IE and OUD who were discharged home had significantly longer lengths of stay in acute care hospitals (32.9 vs. 15.3 days; p < 0.01) and excessive hospital charges ($308,874 vs. $188,862) compared to those without OUD. Conclusions: Major changes have occurred in the demographics of IE in SC. The increasing incidence rate of IE in younger adults with OUD coupled with prolonged stays at acute care hospitals pose challenges to the healthcare system that require creative solutions. Full article