From the Guidelines
Enterococcus faecalis is a gram-positive bacterium that can cause serious infections, and treatment typically involves antibiotics such as ampicillin or vancomycin, with combination therapy with an aminoglycoside like gentamicin for severe infections like endocarditis. The most recent and highest quality study, 1, recommends that fully penicillin-susceptible strains of Enterococcus spp. be treated with penicillin G or ampicillin combined with gentamicin. However, gentamicin resistance is frequent in both E. faecalis and E. faecium, and an aminoglycoside MIC ≥500 mg/L (HLAR) is associated with the loss of bactericidal synergism with cell wall inhibitors, and aminoglycosides should not be used in such conditions.
- Key considerations in the treatment of Enterococcus faecalis infections include:
- Susceptibility testing to guide antibiotic selection
- Combination therapy with an aminoglycoside for severe infections like endocarditis
- Monitoring for antibiotic resistance, particularly to vancomycin (VRE)
- Prevention measures such as proper hand hygiene, contact precautions, and antibiotic stewardship to limit resistance development
- The recommended treatment regimens for Enterococcus faecalis infections vary depending on the infection site and severity, but typically involve antibiotics such as ampicillin (2g IV every 4-6 hours) or vancomycin (15-20 mg/kg IV every 8-12 hours) for 7-14 days, with combination therapy with an aminoglycoside like gentamicin (1 mg/kg IV every 8 hours) for severe infections like endocarditis, and treatment duration extends to 4-6 weeks, as recommended by 1 and 1.
- It is essential to note that Enterococcus faecalis can develop antibiotic resistance, particularly to vancomycin (VRE), making infections difficult to treat, and susceptibility testing is crucial before initiating therapy, as highlighted by 1, 1, and 1.
- In cases where the strain is resistant to gentamicin, alternative treatments such as streptomycin or a double β-lactam regimen may be considered, as recommended by 1.
- The treatment of Enterococcus faecalis infections requires careful consideration of the antibiotic regimen, and consultation with an infectious disease specialist is recommended, especially in cases of complex or resistant infections, as emphasized by 1.
From the Research
Enterococcus casefaliis
- There is no direct information available on Enterococcus casefaliis in the provided studies.
- However, the studies do provide information on Enterococcus species, including Enterococcus faecalis and Enterococcus faecium, which may be relevant.
- Enterococcus faecalis and Enterococcus faecium are known to be opportunistic pathogens that can cause a range of infections, including endocarditis, bacteremia, and urinary tract infections 2, 3, 4.
- Treatment of Enterococcus infections can be challenging due to antibiotic resistance, and various treatment options have been explored, including ampicillin, gentamicin, quinupristin/dalfopristin, linezolid, and daptomycin 2, 3, 5.
- A study comparing ampicillin plus ceftriaxone (AC) to ampicillin plus gentamicin (AG) for the treatment of Enterococcus faecalis endocarditis found that AC was non-inferior to AG and associated with fewer adverse events 3.
- Another study reviewed the clinical features and treatment of Enterococcus casseliflavus infections, which can be resistant to vancomycin, and found that ampicillin was effective in treating bacteremia caused by this species 4.
- The emergence of vancomycin-resistant enterococci (VRE) has led to the development of new antibiotics, such as quinupristin/dalfopristin and linezolid, which have shown efficacy against VRE in clinical trials 5.
- However, resistance to these new antibiotics has already been reported, highlighting the need for continued surveillance and development of new treatment options 6.