Dalbavancin to Complete a Prolonged Antibiotic Course for Persistent Bacillus cereus Bacteremia: A Case Report and Literature Review.

Bacillus cereus is a Gram-positive, rod-shaped facultative anaerobe commonly associated with gastrointestinal infections. Although typically regarded as a blood culture contaminant, B. cereus can cause severe infections, including bacteremia, in high-risk patients. We report a case of a 39-year-old male with a history of intravenous drug use (IVDU) presenting with fevers and found to have B. cereus bacteremia. Cultures remained persistently positive for B. cereus despite 7 days of therapeutic vancomycin. Gentamicin was initiated for Gram-positive synergistic effect with vancomycin. This combination of gentamicin and vancomycin resulted in blood culture clearance. On discharge, he received one dose of dalbavancin and oral levofloxacin for 21 days to complete a total 4-week antibiotic course from date of blood culture clearance. This case demonstrates that dalbavancin may be a promising alternative to standard treatments for prolonged antibiotic courses of B. cereus infections, particularly when intravenous access is a challenge.