Cases of a potentially fatal heart infection have increased 10-fold among people injecting drugs in North Carolina, HealthDay reports.

The infection, called endocarditis, can develop if a person injects bacteria into the bloodstream by not properly sterilizing the skin, or by injecting non-sterile water or drugs. Researchers found a sharp rise in endocarditis-related hospitalizations and surgeries involving people who injected drugs between 2007 and 2017. Most of the increase occurred since 2013. The findings were reported at a meeting of infectious disease experts.

“We know that drug-associated endocarditis is increasing nationally, but the magnitude of the rise has been somewhat stunning,” said study author Dr. Asher Schranz of the University of North Carolina at Chapel Hill. “In our study, we found that this problem has continued to sharply rise through at least mid-2017.”

Dr. Schranz added that endocarditis has become “a severe consequence of the opioid crisis that has received insufficient attention.”