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Serratia marcescens infectious endocarditis (SMIE) is an uncommon disease, and the largest case series were reported from California in the 1970s. We aimed to identify risk factors and outcomes of SMIE in our institution.Retrospective cohort study of all cases of Serratia marcescens bacteremia (SMB) diagnosed between January 2003 and December 2013.A total of 298 cases of SMB were reviewed, and 5 cases of SMIE were found. Clinical characteristics between SMB and SMIE cases were similar, except for more frequent history of injection drug use among cases of SMIE. Serratia marcescens infectious endocarditis cases had large vegetations, frequent embolic events, and poor outcomes.We confirm the stereotypical description of SMIE as a cause left-sided heart disease in injection drug users with frequent embolic events. Poor outcomes prevailed despite advances in medical care.