Leclercia adecarboxylata is an emerging gram‐negative pathogen. Historically, it has primarily affected immunocompromised individuals and has mainly been isolated from polymicrobial infections. Yet, advances in diagnostic techniques have led to increased recognition of its incidence and clinical relevance. In this case series, two instances of monomicrobial L. adecarboxylata infections following neurosurgical procedures in immunocompetent patients are presented. The first case occurred after spinal laminectomy, and the other case caused external ventricular drain ventriculitis. Both patients responded well to targeted antibiotic therapy, with no sequela or recurrence of infection. These cases represent the first documented neurosurgical infections caused by L. adecarboxylata , highlighting the organism’s potential as a nosocomial pathogen and underscoring the need for heightened clinical awareness and further investigation into its epidemiology to prevent further infections.

Background: Candida auris is an emerging nosocomial fungal pathogen whose inherent multidrug resistance and ability to form biofilms make treatment extremely difficult. Given the limited number of therapeutic options available and the poor clinical outcomes associated with current therapeutics, this study evaluated the potential of repurposing existing agents to treat C. auris infections. Methods: Six clinical C. auris isolates from a single tertiary care center were tested for in vitro susceptibility to topical agents (hypochlorous acid, chlorhexidine gluconate, sodium hypochlorite) and systemic agents (N-acetylcysteine, ethylenediaminetetraacetic acid, ethyl pyruvate). Furthermore, these six isolates were allowed to form biofilms and the ability of repurposed agents to disrupt C. auris biofilms was measured. Results: All agents except N-acetylcysteine demonstrated inhibitory activity against planktonic C. auris. With respect to C. auris biofilms, these were characterized using electron microscopy and all six agents showed statistically significant (p < 0.05) ability to disrupt biofilms over controls. Moreover, the ability to disrupt biofilms was also statistically significant (p < 0.05) when compared to use of either normal saline or amphotericin B. Discussion: These findings support the potential clinical utility of repurposing existing agents, such as Ethyl Pyruvate or EDTA, for systemic C. auris infections, or hypochlorous acid for C. auris wound infections. Yet, further studies are needed to optimize dosing parameters and evaluate in vivo efficacy and tolerability.

A 36-year-old male with headaches was empirically treated for herpes simplex virus meningitis; CSF PCR testing later confirmed varicella zoster virus meningitis. Valacyclovir was increased to 2 g QID for remaining duration of therapy with full recovery. This case highlights the importance of comprehensive testing and proper treatment adjustment for rarer etiologies of aseptic meningitis.

Background: People who inject drugs (PWID) comprise the majority of patients with native tricuspid valve (TV) infective endocarditis (IE). Many patients require surgical repair or replacement of their TV, but some may be deemed ineligible for surgical management due to high operative risk or patient preference. Vacuum-assisted percutaneous mechanical aspiration (PMA) has emerged as a potential alternative to surgical management in this population. The objective of this study was to describe real world patient characteristics and clinical outcomes in PWID who underwent PMA or surgical management of TV IE. Methods: We retrospectively reviewed PWID hospitalized with endocarditis at a single tertiary care center (2016–2025) who underwent an isolated PMA or surgical TV repair/replacement (TVR). Baseline demographic, clinical, microbiologic, and echocardiographic characteristics were described. Clinical outcomes were compared descriptively between groups, recognizing imbalances in treatment selection. Results: 40 PWID met inclusion criteria; 17 underwent PMA and 23 underwent surgical TVR. There was substantial baseline clinical heterogeneity between the two groups. Procedural success was numerically higher with surgery than PMA (95.7% vs 88.2%). Clinical success, a composite of procedural success, treatment completion, and lack of need for reintervention, was numerically higher in the TVR group (73.9% vs 52.9%). One-year mortality was similar between groups. Conclusion: In this single-center retrospective observational cohort of PWID with TV IE, patients who underwent PMA experienced lower rates of procedural and clinical success compared with TVR, although outcomes may be reflective of baseline differences between groups. These findings emphasize the importance of patient selection when deciding on TV IE intervention. PMA may be a feasible source-control strategy for select patients not eligible for immediate surgery; however, larger prospective studies are needed to define optimal patient selection factors and comparative effectiveness.

Antibiotics primarily exert their effect on planktonic microbial states, limiting their ability to eradicate biofilms commonly seen in chronic infections. This is because the minimal inhibitory concentration of antibiotics needed to kill microbes in biofilms can be up to 1000 times greater than when microbes are in their planktonic state. Yet up to 70% of all chronic infections are associated with a biofilm component. Consequently, novel therapeutics are needed to aid in the treatment of chronic biofilm infections. One such approach is to repurpose drugs that have demonstrated safety for non-infectious clinical indications. The main advantage of this approach is that the agents have already been shown to be safe for human administration, which can expedite clinical trial development of agents for biofilm infections. Unfortunately, most clinicians are unaware of the antimicrobial properties of some commonly used drugs. Thus, the aim of this Perspective was to discuss the potential of four drugs that have theoretical promise as adjuvants in the treatment of chronic biofilm infections. This was accomplished by providing detailed discussion of each agent with respect to current clinical use, potential mechanisms of antimicrobial activity, and present data to support use as adjuvant biofilm agents.