Right-sided infective endocarditis due to methicillin-resistant Staphylococcus aureus in an injecting drug user: outbreak or slow epidemic?

We present a case of right-sided infective endocarditis due to methicillin-resistant Staphylococcus aureus that occurred in an injectable drug user. Traditionally, cities such as Detroit and San Francisco have been associated with certain bacterial infections. Upon further review, these relationships appear more tenuous and argue that identification to the level of "strain" will be required to support such claims. We argue here that this was a case that was part of a larger epidemic that has been slowly evolving over the past several years.