Oritavancin as sequential therapy for vancomycin-resistant Enterococcus faecium prosthetic valve endocarditis: a case report.

We report the case of a 91-year-old man with prosthetic valve endocarditis (PVE) caused by vancomycin-resistant Enterococcus faecium (VRE), successfully managed with an initial two-week course of intravenous daptomycin and fosfomycin, followed by six once-weekly outpatient infusions of oritavancin. The diagnosis was established based on positive blood cultures and transoesophageal echocardiography findings. In the challenging epidemiological setting of Greek hospitals-characterized by endemic multidrug-resistant organisms and a high burden of healthcare-associated infections-minimizing hospitalization is a key consideration. Oral linezolid was avoided due to its bacteriostatic activity, relatively low serum levels, and the risk of myelotoxicity in elderly patients. The patient achieved complete clinical and microbiological resolution and remained relapse-free at six months of follow-up. This case highlights the feasibility of long-acting lipoglycopeptides, such as oritavancin, as sequential therapy to enable outpatient completion of prolonged treatment in selected patients with VRE prosthetic valve endocarditis.