It is noteworthy that healthcare exposure was asso- ciated with the development of IE caused by this group of organisms in 57% of patients. In contrast, IDU, a prominent risk factor for the development of this IE syndrome in ear- lier years, was recognized in only 4% of cases in the mul- tinational survey that included cases seen between 2000 and 2005. Escherichia coli and Pseudomonas aeruginosa accounted for 51% of cases, and 59% had PVE. Although management included cardiac surgery in 51% of cases, the in-hospital mortality rate was 24%. Despitethe very rare occurrence ofIE causedby Salmonella species in North America, this syndrome deserves specific mention because it occurs with some frequency in other geo- Salmonella species have a proclivity to infect cardiovascular structures in adults. Therefore, all patients with bloodstream infection resulting from Salmonella species should be evaluated for complicating cardiovascular infec- tions, including IE, myocarditis, pericarditis, and endarteritis. Although many serotypes have been implicated, most cases are caused by S choleraesuis, S typhimurium, and S enteritidis.222 Cardiac surgery in combination with prolonged courses of combined antibiotic therapy is reasonable for most patients with IE caused by non-HACEK Gram-negative aerobic bacilli, particularly in the setting of left-sided valvular involvement. Prospective trial data are lacking to define the optimal antimicrobial regimen for the treatment of IE caused by non- HACEK Gram-negative aerobic bacilli. Input from special- ists in infectious diseases who are experienced in the medical management of IE should be obtained to define an antibiotic regimen in each case. This is particularly important in IE caused by non-HACEK Gram-negative aerobic bacilli for sev- eral reasons. First, as stated previously, healthcare exposure is commonly seen in these cases; thus, multidrug resistance often characterizes these pathogens. 