An inoperable mediastinal infection involving vascular graft treated with weekly oritavancin as chronic suppressive therapy. A case report with pharmacokinetic data

Dear Editor, Two long-acting antibiotics, namely dalbavancin and oritavancin, have recently gained attention for potential off-label use in the cure of several infections, particularly those requiring prolonged treatments, such as endocarditis, osteomyelitis, infections of orthopaedic and cardiovascular prostheses and spondylodiscitis.1–6 Evidence on the use of lipoglycopeptides in the treatment of infections involving cardiac and vascular prostheses is limited to retrospective studies or case reports/series and, more often, studies regard dalbavancin than oritavancin. Also, data on lipoglycopeptides pharmacokinetics are more frequently encountered about dalbavancin than oritavancin. We describe the case of a patient with an inoperable mediastinal infection involving vascular prosthesis treated with oritavancin as chronic suppressive therapy, together with pharmacokinetic data. Our patient in 2017 underwent substitution of the aortic valve, ascending aorta and aortic arch with a biologic aortic valvular prosthesis and a Gelweave 32 tube graft (Biobentall procedure) plus elephant trunk with a Gelweave 26 graft. In 2023 he also received an endovascular repair of a thoraco-abdominal aneurysm by an endoprosthesis of the thoracic aorta and a T-branched abdominal aortic endograft.