Serratia endocarditis. A follow-up report

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Abstract
Of 17 cases of S. marcescens endocarditis observed in the San Francisco Bay Area [USA] since June 1974, 15 had a history of illicit i.v. drug use and 4 had prosthetic heart valves. Seven patients with infection of right-sided heart valves did well, although surgery was required in 2 for persistent fever or recurrent pulmonary emboli. Of 10 patients with left-sided infection, only 3 survived despite synergistic antibiotic combinations and high serum bactericidal titers. Isolates (15) of Serratia from patients with endocarditis were serotyped and none of these serotypes corresponded to the pigmented strain aerosolized by the USA Army in the Bay Area in 1951. Isolation of the same Serratia strain from 2 patients and their shared injection paraphenalia provided insight into the pathogenesis of endocarditis in the i.v. drug user. A revised therapeutic approach to this difficult infection is presented.

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