Background: With evolving risk factors, the frequency of right-sided infective endocarditis (RSIE) is increasing. Despite its distinct clinical features, data on RSIE remain limited, and no dedicated cohort has been reported from Türkiye. This study aimed to describe the epidemiological and clinical characteristics of RSIE and identify factors associated with mortality in a tertiary-care center.

Methods: This retrospective cohort study evaluated 65 adult patients diagnosed with definite RSIE between January 2018 and January 2024. Demographic data, risk factors, echocardiographic findings, causative microorganisms, and outcomes were analyzed. Statistical comparisons were performed between intravenous drug use (IVDU) and non-IVDU groups.

Results: The cohort was predominantly male (76.9%) with a median age of 36 years. Intravenous drug use was the primary risk factor (55.4%), followed by central venous catheters (24.6%) and hemodialysis (23.1%). Staphylococcus aureus was the leading causative agent (79%). Septic pulmonary embolism was detected in 81.6% of patients. The overall in-hospital mortality rate was 26.2%. Mortality was significantly lower in IVDU patients than in non-IVDU patients (17.4% vs. 44%; P = .036); however, multiple regression analysis identified hemodialysis as an independent predictor of mortality (OR = 6.72, 95% CI: 1.27-35.42; P = .025). Multiple Cox regression analysis further demonstrated that hemoglobin level and age were independent predictors of mortality.

Conclusion: Although IVDU patients demonstrated higher survival rates—likely attributable to a younger age profile and fewer comorbidities—RSIE remains a critical condition requiring high clinical suspicion and early intervention. RSIE in this region is strongly associated with IVDU and typically presents with respiratory symptoms due to septic pulmonary emboli.