Mansur and colleagues1 deserve to be commended for their large series dealing with the complications of infective endocarditis in the 1980s, highlighting the changing scenario from heart failure to uncontrolled infection and neurologic complications as the leading cause of death. Certain issues, however, require clarification in this regard.
The investigators make scant mention of the presence and extent in their patient population of, perhaps, the most important new factor in the 1980s, the scourge of intravenous drug abuse. Endocarditis among parenteral drug abusers has become common enough to shift the overall distribution of causative organisms and complications, especially in large urban centers.2 Complications in this group of patients are important for several reasons. Staphylococcus aureus is the most common organism isolated from patients with narcotic-related endocarditis, and is associated with septic complications more frequently than other important pathogens. The right side of the heart is involved in 50%