From the Guidelines
The recommended treatment for Enterococcus gallinarum infections is linezolid 600 mg IV or PO every 12 hours, as it is effective against enterococcal infections, including those caused by E. gallinarum, with a strong recommendation and low quality of evidence 1.
Key Considerations
- Enterococcus gallinarum possesses intrinsic low-level vancomycin resistance (VanC phenotype), which may limit the effectiveness of vancomycin therapy.
- Combination antibiotic therapy, such as ampicillin or penicillin plus an aminoglycoside, may be considered for serious infections, but susceptibility testing is crucial to guide therapy.
- Daptomycin, at a dose of 8-12 mg/kg daily, may be an effective alternative for treating VRE bacteremia, including infections caused by E. gallinarum, with a weak recommendation and low quality of evidence 1.
- Tigecycline may be considered for intra-abdominal infections caused by VRE, including E. gallinarum, due to its broad-spectrum activity and high penetration into the peritoneal space.
Treatment Duration and Monitoring
- Treatment duration generally ranges from 7-14 days for uncomplicated infections to 4-6 weeks for endocarditis or bone/joint infections.
- Monitoring of creatine kinase (CK) levels is recommended when using high-dose daptomycin.
- Infection disease specialist consultation is suggested in patients with poor treatment response or when longer duration of treatment is considered.
Additional Considerations
- Surgical intervention may be necessary for abscesses or infected devices.
- Novel agents, such as eravacycline, may exhibit in vitro activity against VRE, but currently, there is no complete evidence available to provide guidance on its role for VRE infections.
- Ceftaroline should not be empirically used for the treatment of VRE infections due to its poor activity against enterococcus.
From the FDA Drug Label
The cure rates for the ITT population with documented vancomycin-resistant enterococcal infection at baseline are presented in Table 15 by source of infection.
The recommended treatment for Enterococcus gallinarum infections is linezolid (PO), as it has been shown to be effective in treating vancomycin-resistant enterococcal infections, which includes Enterococcus gallinarum 2.
- Key points:
- Linezolid has been studied for the treatment of vancomycin-resistant enterococcal infections.
- The cure rates for linezolid-treated patients with documented vancomycin-resistant enterococcal infection were higher in the high-dose arm than in the low-dose arm.
- The cure rate was 67% for patients with any site of infection, and 59% for patients with associated bacteremia.
From the Research
Treatment Options for Enterococcus gallinarum Infections
- The recommended treatment for Enterococcus gallinarum infections is not well-established, but several studies suggest that a combination of antibiotics may be effective 3, 4, 5.
- Daptomycin and gentamicin have been used successfully to treat a patient with Enterococcus gallinarum sepsis 3.
- Linezolid and daptomycin are also commonly used to treat vancomycin-resistant Enterococcus (VRE) bacteremia, including those caused by Enterococcus gallinarum 6, 5.
- A systematic review and meta-analysis found that linezolid may be more effective than daptomycin in treating VRE bacteremia, with lower 30-day all-cause mortality and infection-related mortality rates 6.
- Another study found that treatment with linezolid or daptomycin resulted in improved clinical outcomes compared to anti-enterococcal β-lactam treatment for vancomycin-resistant Enterococcus gallinarum or Enterococcus casseliflavus bloodstream infections 5.
Specific Treatment Regimens
- For bloodstream infections, endocarditis, central nervous system infections, endophthalmitis, and urinary tract infections caused by Enterococcus gallinarum, therapeutic algorithms have been proposed 4.
- Meropenem has been used to treat a patient with Enterococcus gallinarum meningitis, but the patient's fever and headache did not show significant relief 7.
- The choice of antibiotic therapy should be guided by susceptibility testing and clinical experience 4, 5.
Infection Control Measures
- Infection control measures should be implemented on a case-by-case basis, especially for epidemic outbreaks or for isolates supposed to harbor a potential transmissible vancomycin-resistance phenotype 4.
- Avoiding long-term invasive treatment and improving immunity may help reduce the occurrence of Enterococcus gallinarum infections 7.
- Early detection and diagnosis, as well as rational antibiotic use, are key to achieving satisfactory efficacy in treating Enterococcus gallinarum infections 7.