There is scarce information on the actual incidence of candidemia in COVID-19 patients. In addition, comparative studies of candidemia episodes in COVID-19 and non-COVID-19 patients are heterogeneous. Here, we assessed the real incidence, epidemiology, and etiology of candidemia in COVID-19 patients, and compared them with those without COVID-19 (2020 vs. 2019 and 2020, respectively). We also genotyped all C. albicans, C. parapsilosis, and C. tropicalis isolates (n = 88), causing candidemia in both groups, providing for the first time a genotypic characterization of isolates gathered in patients with either COVID-19 or non-COVID-19. Incidence of candidemia was higher in patients with COVID-19 than non-COVID-19 (4.73 vs. 0.85 per 1000 admissions; 3.22 vs. 1.14 per 10,000 days of stay). No substantial intergroup differences were found, including mortality. Genotyping proved the presence of a low number of patients involved in clusters, allowing us to rule out rampant patient-to-patient Candida transmission. The four patients, involved in two clusters, had catheter-related candidemia diagnosed in the first COVID-19 wave, which demonstrates breaches in catheter management policies occurring in such an overwhelming situation. In conclusion, the incidence of candidemia in patients with COVID-19 is significantly higher than in those without COVID-19. However, genotyping shows that this increase is not due to uncontrolled intrahospital transmission.

Enterococcal endocarditis (EIE) affects elderly patients, with high rates of complications and mortality, and dalbavancin (DBV) exhibits significant antimicrobial activity against most enterococci. However, data are lacking on the use of DBV in EIE. The main objective was to evaluate the outcomes of treatment with DBV in the consolidation therapy of IE by Enterococcus spp. Spanish-French retrospective observational study of patients with EIE enrolled between November 2016 and June 30, 2022 receiving DBV in consolidation phase and followed for ≥12 months. Ninety-eight patients were enrolled, 69.4 % male, with mean age of 71.2 (±12.51) years and median Charlson index of 5 (IQR 3-7). Criteria for definite IE were met by 84.7%; 60.2 % had IE on native valve, 26.5 % late prosthetic IE, 8.2 % early prosthetic IE, 2 % cardiovascular implantable electronic-IE (CIE-IE), and 3.1 % CIE-IE and valve. Aortic valve involvement was observed in 66.3 %. E. faecalis was isolated in 86.7 %, E. faecium in 11.2 %; 32.6 % underwent surgery, and these had a higher cure rate (100 % vs 75.8 %; p = 0.005) and lower mortality (0 vs 13.6 %; p = 0.029). DBV was administered to facilitate discharge in 88.8 %. Total dose was 2500 mg (1500-3000) over 3.5 weeks (2-4). Loss to follow-up was 0 %, relapse rate 8.2 %, 1-year IE-related mortality 3.1 %, and clinical cure rate 81.2 %. Severe adverse events affected 1 % (acute tubular necrosis). Hospital stay was reduced by 21 days (14-28). DBV appears to be highly effective, safe, and cost-effective as consolidation therapy in patients with IE caused by Enterococcus spp., with minimal adverse events.

Background: Abiotrophia spp. and Granulicatella spp. are Gram-positive cocci, formerly known as nutritionally variant or deficient Streptococcus. Their role as causative agents of infective endocarditis (IE) is numerically uncertain, as well as diagnostic and clinical management of this infection. The aim of our study is to describe the clinical, microbiological, therapeutic, and prognosis of patients with IE caused by these microorganisms in a large microbiology department. Methods: Retrospective analysis of all the patients with Abiotrophia spp. and Granulicatella spp. IE registered in our centre in the period 2004–2021. Results: Of the 822 IE in the study period, 10 (1.2%) were caused by Abiotrophia spp. (7) or Granulicatella spp. (3). The species involved were A.defectiva (7), G.adiacens (2) and G.elegans (1). Eight patients were male, their mean age was 46 years and four were younger than 21 years. The most frequent comorbidities were congenital heart disease (4; 40%) and the presence of intracardiac prosthetic material (5; 50%). IE occurred on 5 native valves and 5 prosthetic valve or material. Blood cultures were positive in 8/10 patients, within a mean incubation period of 18.07 hours. In the other two patients, a positive 16SPCR from valve or prosthetic material provided the diagnosis. Surgery for IE was performed in seven patients (70%) and in all cases positive 16S rRNA PCR and sequencing from valve or prosthetic material was demonstrated. Valves and/or prosthetic removed material cultures were positive in four patients. Nine patients received ceftriaxone (4 in monotherapy and 5 in combination with other antibiotics). The mean length of treatment was 6 weeks and IE-associated mortality was 20% at one year follow-up. Conclusions: Abiotrophia spp. or Granulicatella spp. IE were infrequent but not exceptional in our environment and particularly affected patients with congenital heart disease or prosthetic material. Blood cultures and molecular methods allowed the diagnosis. Most of them required surgery and the associated mortality, in spite of a mean age of 46 years, was high.

Introduction The management of complicated Gram-positive bloodstream infections (cBSI) and infective endocarditis (IE) often requires prolonged intravenous therapy. Transition to oral therapy is frequently unfeasible because of resistance, drug interactions, or adherence concerns, increasing the risk of intravenous-related complications and healthcare burden. The pharmacokinetic profile and spectrum of oritavancin may enable effective treatment and early discharge. This study evaluated its effectiveness, safety, and impact on hospital resource use in patients with cBSI or IE. Methods We conducted a multicenter, retrospective, observational study across eight hospitals in Italy and Spain (April 2023–February 2025). Adult patients with Gram-positive cBSI (persistent/refractory BSI or prosthetic material) or IE (2023 modified Duke criteria) treated with ≥ 1 dose of oritavancin were included. Dosing was determined by the treating physicians. Data on outcomes, adverse events (AEs) and healthcare use were collected from medical records. Patients were followed for at least 6 months. Results Twenty-seven patients were included: 13 (48.1%) cBSI and 14 (51.9%) IE. Median age was 73 years (IQR 65–81); 18 out of 27 (66.7%) were male; Charlson Comorbidity Index 6 (IQR 4–7). In cBSI, oritavancin was first-line in 6/13 (46.2%) and given in multiple doses in 8/13 (61.6%), median of 2 doses (IQR 2–2.5). Clinical success was 100%, with no recurrence or BSI-related mortality. In IE, Staphylococcus aureus was identified in 5 of 14 cases (35.7%), of which 40% were methicillin-resistant. Native valves were involved in 6/14 (42.8%), prosthetic valves in 6/14 (42.8%), cardiac devices in 2/14 (14.3%). Clinical success was achieved in 85.7% of patients with IE (12/14). Two AEs occurred: nausea and a non-fatal acute coronary syndrome in a patient with pre-existing ischemic heart disease. Oritavancin use reduced 369 hospital days with potential savings of approximately €4235 per patient. Conclusions Oritavancin may represent a safe, effective treatment option for selected patients with cBSI or IE, with advantages in outcomes, reduced hospital stay, and cost containment.