Agromyces mediolanus is a catalase-positive gram-positive rod typically found in the soil and not commonly known to be pathogenic. We present a rare case of Agromyces mediolanus bacteremia with aortic valve endocarditis in a patient who required prolonged inpatient care with a tunneled dialysis catheter for renal replacement therapy (RRT). Infection is the second leading cause of mortality among patients with end-stage renal disease and vascular access. The incidence of bacteremia is higher in patients with indwelling tunneled catheters than in those with an arteriovenous fistula or graft. The most critical risk factor is its prolonged use. Anticipation of the need for long-term definitive renal replacement therapy and planning for the best approach is crucial in preventing catheter-related bloodstream infections (CRBSIs). Human infections caused by Agromyces mediolanus are rare; it has been reported twice, and both cases were associated with prolonged use of catheters, not only parenteral catheter but also peritoneal catheter, which is of special importance for patients with end-stage renal disease (ESRD). Limited data is available for the appropriate antibiotic therapy.