Limited data exist on recent demographic and microbiological changes in infective endocarditis (IE) and the impact of these changes on patient survival. Therefore, Cabell et al sought to identify changes in demographic and microbiological characteristics in patients with endocarditis and to determine relationships between changing characteristics and survival. Data were collected from all patients with definite or possible IE at Duke University Medical Center from 1993 to 1999. Among the 329 study patients, rates of hemodialysis dependence, immune suppression, and Staphylococcus aureus infection increased during the study period, while rates of infection due to viridans group streptococci decreased. Patients with S aureus IE had a higher 1-year mortality rate (43.9% vs 32.5%) that persisted after adjustment for other illness severity characteristics. In this study, Cabell et al found that the demographic and microbiological characteristics of IE at their institution have changed over the past decade in ways that suggest a link between medical practice and IE characteristics. S aureus has emerged as a dominant cause of IE and is an independent predictor of mortality. These findings identify clinical settings that may warrant closer surveillance and more aggressive measures in the identification and prevention of endocarditis.