Streptococcus intermedius is frequently associated with brain and liver abscesses, while pleuropulmonary infections are considered rarer. Even less frequent is the association of lung and brain abscesses due to this agent with infective endocarditis. We describe the case of a 40-year-old man complaining of cough, fever, and headache who was diagnosed with a brain abscess due to S. intermedius, a concomitant lung abscess, and aortic native valve endocarditis. He was treated with surgical drainage of the brain abscess and a 4-week course of intravenous ceftriaxone, followed by oral amoxicillin/clavulanate, obtaining healing of the lesions without relapse of the infection.

Background: Dalbavancin and oritavancin are long-acting lipoglycopeptides increasingly used off-label for a variety of Gram-positive infections. While their efficacy has been described in osteomyelitis, bacteremia, and infective endocarditis, evidence specifically addressing cardiovascular prosthetic infections such as prosthetic valve endocarditis (PVE), cardiac implantable electronic device (CIED) infections, left ventricular assist device infections (LVAD), and prosthetic vascular graft infections (PVGI) remains limited. These conditions are particularly challenging due to biofilm formation, difficulties in achieving surgical source control, and the frequent need for prolonged or suppressive therapy. Objectives: This systematic review aimed to summarize the available literature on the use of dalbavancin and oritavancin in cardiovascular prosthetic infections, with a focus on therapeutic strategies, clinical outcomes, and safety. Methods: We performed a systematic search of PubMed, Embase, Scopus, and Cochrane Library up to 24 June 2025 in accordance with PRISMA guidelines. Eligible studies included adults treated with dalbavancin or oritavancin for cardiovascular prosthetic infections. Data on study characteristics, population demographics, causative pathogens, and microbiological profiles, antibiotic regimens, treatment duration, use of therapeutic drug monitoring (TDM), indication or non-indication for chronic suppressive therapy, adverse events, clinical outcomes, and clinical efficacy were extracted. Results: Twenty studies comprising 113 patients were identified, of whom 111 received dalbavancin and 2 oritavancin. The main infections were PVE, CIED, LVAD, and PVGI. Dalbavancin was most effective as consolidation therapy after surgery or device removal, with high cure rates. Prolonged regimens were used as bridging or in partially treated cases, sometimes supported by TDM or PET/CT. Chronic suppressive therapy, mainly for LVAD and PVGI infections, achieved variable outcomes with relapses in about one fifth of patients. Adverse events were infrequent and generally mild. Conclusions: The included studies were highly diverse, conducted in various settings and with different objectives. Eight of the twenty included studies were single case reports on dalbavancin and oritavancin, highlighting the predominance of individual case descriptions in the available literature. Long-acting lipoglycopeptides may represent a valuable option for cardiovascular prosthetic infections. Their role appears most favorable as consolidation after adequate source control, while chronic suppressive use showed heterogeneous outcomes. This systematic review was registered on Open Science Framework. This work was supported by grants from the Italian Ministry of Health through Ricerca Corrente, Linea 3, Progetto 3.

Pneumonia remains a leading cause of morbidity and mortality worldwide, with bacterial pathogens contributing significantly to its burden. While Pseudomonas aeruginosa and Acinetobacter baumannii complex are well-recognized non-fermenting Gram-negative bacteria (NFGNB) causing severe pneumonia, particularly in healthcare settings, an expanding array of other, rarer NFGNB species is increasingly implicated. These species include, but are not limited to, Achromobacter spp., Ochrobactrum spp., Burkholderia spp., Aeromonas spp., Roseomonas spp., Elizabethkingia spp., Chryseobacterium spp. Alcaligenes spp., Ralstonia spp., Cupriavidus spp., Sphingomonas spp., Rhizobium spp., Empedobacter spp., and Brevundimonas spp. In this article we aim to provide a focused review of the contemporary epidemiology and specific risk factors for pneumonia caused by this diverse group of rare NFGNB, explicitly excluding P. aeruginosa, Stenotrophomonas maltophilia, and A. baumannii. We seek to delineate the emerging patterns of pneumonia associated with Achromobacter spp., Burkholderia spp., Aeromonas spp., Roseomonas spp., Elizabethkingia spp., Pandoraea spp., Sphingomonas spp., and K. gyiorum. Moreover, we discuss antimicrobial treatment strategies for pneumonia caused by rarer NFGNB including Ochrobactrum spp., Chryseobacterium spp., Alcaligenes spp., Ralstonia spp., Cupriavidus spp., Rhizobium spp., Empedobacter spp., and Brevundimonas spp. A deeper understanding of these specific epidemiological trends and risk factors is important for guiding precise diagnostic approaches, informing antimicrobial stewardship programs, and developing targeted infection prevention and control strategies with the aim of mitigating the impact of these challenging pathogens in the clinical setting.

Streptococcus intermedius is frequently associated with brain and liver abscesses, while pleuropulmonary infections are considered rarer. Even less frequent is the association of lung and brain abscess due to this agent with left heart endocarditis. We describe the case of a 40-year-old man with a brain abscess due to S. intermedius and concomitant lung abscess and aortic native valve endocarditis. He was treated with surgical drainage of the brain abscess and a 4-week course of intravenous ceftriaxone, followed by oral amoxicillin/clavulanate, obtaining healing of the lesions without relapse of the infection.

Brucellar endocarditis is a rare entity commonly described as a severe disease associated with high mortality and generally requiring valve surgery for cure. Right-sided endocarditis, a very uncommon presentation of brucellosis, may be associated with a better prognosis. We describe the case of a 72-year-old woman admitted to our institution with a persistent fever and multiple pulmonary infiltrates. Transthoracic echocardiography and serologic tests led to the diagnosis of brucellar tricuspid endocarditis. The patient responded favorably to antibiotic treatment alone and did not need surgery. Prolonged antibiotic therapy with a combination of drugs active on intracellular microorganisms in the absence of surgical treatment could be effective in brucellar tricuspid endocarditis when the valve is not severely damaged.

Background/Objectives: Multidrug-resistant (MDR) Pseudomonas aeruginosa pneumonia and bloodstream infections (BSI) remain challenging because of their severity, limited therapeutic options, and high mortality, despite the availability of novel β-lactam-based agents. We aimed to describe real-world treatment patterns, characteristics associated with treatment and infusion-strategy selection, and the association of these strategies with clinical outcomes in the retrospective, multicentre Italian SUSANA cohort, an observational study evaluating the use, safety, and outcomes of novel antibiotics in hospitalized patients. Methods: Adults with MDR P. aeruginosa pneumonia and/or BSI treated with novel antipseudomonal agents for ≥72 h were included. Treatment was classified as monotherapy or combination therapy, and infusion strategy as prolonged/continuous or standard. The primary outcome was 28-day all-cause mortality. A multivariable Cox regression analysis was performed. Results: Among 173 patients, pneumonia was the most frequent clinical presentation (74.0%). Monotherapy was used in 111 patients (64.2%), combination therapy in 62 (35.8%), and prolonged/continuous infusion in 120 (69.4%). Ceftolozane–tazobactam (CT) (64.7%) and ceftazidime–avibactam (CZA) (20.2%) were the most prescribed agents. Patients receiving prolonged/continuous infusion, regardless of monotherapy or combination therapy, had greater baseline clinical severity than those receiving standard infusion. Overall, 28-day mortality was 23.7%. In the multivariable analysis, neither combination therapy nor prolonged/continuous infusion was independently associated with reduced mortality, whereas septic shock (aHR 4.10, 95% CI 1.01–16.66) and ICU admission (aHR 2.53, 95% CI 1.06–6.08) increased mortality risk. Conclusions: In this multicentre real-world cohort, treatment strategies for MDR P. aeruginosa pneumonia and BSI appeared to be influenced by baseline severity and patient-related factors. Mortality was more strongly associated with markers of severe illness, including ICU admission and septic shock. No independent association with improved survival was observed for combination therapy compared with monotherapy or for prolonged/continuous compared with standard infusion. These findings highlight the prognostic role of baseline clinical severity and support the need for prospective, randomized, pharmacokinetic/pharmacodynamic (PK/PD)-guided studies to identify patients who may benefit from these strategies.