| Summary: | (1) Background: <i>Actinotignum schaalii</i> is an emerging, opportunistic pathogen often linked with UTIs but can extend beyond the urogenital system. Data on the clinical significance of <i>A. schaalii</i> are still emerging. (2) Methods: A retrospective review of <i>A. schaalii</i> isolates in a Canadian tertiary care hospital was conducted. The clinical data of patients that grew <i>A. schaalii</i> from January 2020 to 2022 were documented. Demographics, site, management, and microbiological parameters surrounding culture and sensitivities were recorded. (3) Results: A total of 43 cases of <i>A. schaalii</i> were identified. <i>Actinotignum schaalii</i> was primarily involved in UTIs (<i>n</i> = 17), abscesses (<i>n</i> = 9), bacteremia (<i>n</i> = 6), septic arthritis (<i>n</i> = 5), and ulcers (<i>n</i> = 5). <i>A. schaalii</i> had a slight predilection for polymicrobial infections (51.1%, <i>n</i> = 22 out of 43), with <i>Aerococcus urinae</i> (<i>n</i> = 5) being the most common coisolate. Susceptibility testing was only performed in two cases that showed sensitivity to beta-lactam antibiotics and resistance to metronidazole and ciprofloxacin. Amoxicillin–clavulanate (<i>n</i> = 5) is the most frequently prescribed antibiotic. (4) Conclusions: The non-urogenic clinical significance of <i>A. schaalii</i> remains undervalued. The management of <i>A. schaalii</i> infection is multimodal, consisting predominantly of antimicrobials and surgical procedures specific to the etiology. Clinicians should request sensitivities for <i>A. schaalii</i> so that appropriate antimicrobial coverage can be provided.
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