In JAMA Network Open, Tan and colleagues 1 performed a retrospective cohort study to describe the occurrence of and risk factors associated with new bloodstream infections (BSIs) and mortality among people who inject drugs (PWIDs) with infective endocarditis. They included 420 consecutive episodes of infective endocarditis occurring in 309 patients from April 1, 2007, to March 31, 2018 3 tertiary hospitals in London, Ontario, Canada. Participants were young (mean [SD] age, 35.7 [9.7] years), with a predominance of Staphylococcus aureus endocarditis (326 [77.6%]) involving the tricuspid valve (296 [70.5%]). Opiates were the most frequently injected substance (365 [86.9%]), but polysubstance use was common (321 [76.4%]), as was homelessness (72 [17.1%]). The investigators found that new BSIs during treatment were common (138 episodes, 68 of which were polymicrobial) but were not significantly associated with mortality.This study was performed in the context of an increasingly well-described epidemic of complex invasive bacterial injection-related infections among PWID. For example, hospitalizations for treatment of drug use-associated infective endocarditis in North Carolina increased 10-fold from 0.10 to 1.38 per 100 000 persons during the same decade that the present study was conducted, and in 2017, 2 in every 5 patients undergoing valve surgery for treatment of endocarditis had injected drugs. 2 Indeed, it is notable that among the 688 episodes of endocarditis screened for inclusion in this study (identified using International Classification of Diseases, Ninth Revision, Clinical Modification, or International Statistical Classification of Diseases, Tenth Revision, Clinical Modification codes for infectious endocarditis), 420 (61.0%) involved patients with a documented Open Access. This is an open access article distributed under the terms of the CC-BY License.