Polymicrobial endocarditis with eight pathogens in an intravenous drug abuser.

A 17-year-old intravenous drug abuser with tricuspid endocarditis required valvulectomy for refractory infection due to 8 different bacterial pathogens. Only one organism was isolated from blood cultures in the first 48 h, and subsequent organisms were not isolated until 9-13 days after hospitalization. The spectrum of pathogens in this patient strengthens previous clinico-bacteriologic observations made in the literature, and emphasizes the need for empiric coverage of oropharyngeal flora in addition to the usual skin flora involved in drug-addict associated endocarditis.