From the Guidelines
The best treatment for a wound infected with Enterococcus faecalis typically involves a combination of wound care and antibiotic therapy, with ampicillin as the first-line antibiotic treatment, usually administered at 2 grams intravenously every 4-6 hours for severe infections, or 500 mg orally four times daily for milder cases, typically for 7-14 days depending on infection severity, as recommended by 1.
Key Considerations
- For patients allergic to penicillins, vancomycin (15-20 mg/kg IV every 8-12 hours) is the preferred alternative, as noted in 1.
- Wound management is equally important and includes thorough cleaning, debridement of necrotic tissue, and appropriate dressing changes.
- For deep or severe infections, surgical debridement may be necessary to remove infected tissue.
- E. faecalis can be challenging to treat because it has intrinsic resistance to many antibiotics and can acquire additional resistance mechanisms.
- In cases of vancomycin-resistant Enterococcus (VRE), linezolid or daptomycin may be required, with daptomycin being preferred for serious VRE infections at a dosing of at least 8 mg/kg and up to 10-12 mg/kg, as recommended by 1.
Antibiotic Therapy
- Ampicillin is the first-line antibiotic treatment for E. faecalis infections, as it is effective against most strains, as noted in 1.
- Vancomycin is an alternative for patients allergic to penicillins, but its use should be guided by antimicrobial susceptibility testing, as recommended by 1.
- Daptomycin is a viable option for VRE infections, with a recommended dosing of 8-12 mg/kg daily, as noted in 1.
- Linezolid may also be used for VRE infections, but its use should be guided by antimicrobial susceptibility testing, as recommended by 1.
Wound Care
- Thorough cleaning and debridement of necrotic tissue are essential for promoting wound healing and preventing further infection.
- Appropriate dressing changes and wound management can help prevent complications and promote recovery.
Special Considerations
- In cases of VRE infections, consultation with an infectious disease specialist is recommended to guide therapy and ensure optimal treatment outcomes, as noted in 1.
- Antimicrobial susceptibility testing should be performed to guide antibiotic therapy and ensure effective treatment, as recommended by 1.
From the FDA Drug Label
Daptomycin has been shown to be active against most isolates of the following microorganisms both in vitro and in clinical infections[see Indications and Usage (1)] Gram-Positive Bacteria Enterococcus faecalis (vancomycin-susceptible isolates only) Staphylococcus aureus (including methicillin-resistant isolates) Streptococcus agalactiae Streptococcus dysgalactiae subsp. equisimilis Streptococcus pyogenes
The best treatment for a wound infected with Enterococcus faecalis is daptomycin (IV), but only for vancomycin-susceptible isolates. For vancomycin-resistant isolates, the efficacy of daptomycin has not been established in adequate and well-controlled clinical trials 2.
- Key points:
- Daptomycin is active against vancomycin-susceptible Enterococcus faecalis.
- The efficacy of daptomycin against vancomycin-resistant Enterococcus faecalis has not been established.
- Vancomycin (IV) may be used in combination with an aminoglycoside for the treatment of infective endocarditis due to Enterococcus species, including E. faecalis 3.
From the Research
Treatment Options for Enterococcus faecalis Wound Infections
- The treatment of Enterococcus faecalis wound infections can be challenging due to the emergence of antibiotic-resistant strains 4.
- Linezolid, an oxazolidinone antibiotic, has been shown to be effective against vancomycin-resistant Enterococcus faecalis, with a minimum inhibitory concentration (MIC) of 2-4 microg/ml 5.
- However, the emergence of linezolid-resistant Enterococcus faecalis has been reported, with resistance attributed to 23S rRNA mutations and the presence of the cfr gene 4.
- Daptomycin, a cyclic lipopeptide antibiotic, has also been shown to be effective against Enterococcus faecalis, but resistance to daptomycin has also been reported 6.
- Combination therapy with daptomycin and ceftaroline has been used to treat central line-associated Enterococcus faecalis bloodstream infections, but the effectiveness of this combination is not well established 6.
Factors Affecting Treatment Outcome
- The outcome of Enterococcus faecalis infective endocarditis treatment has been shown to be affected by the length of antibiotic therapy, with a 4-week course of treatment potentially not being sufficient for uncomplicated native valve infections 7.
- The initial inoculum of Enterococcus faecalis in wound infections can also affect the treatment outcome, with high-dose inocula associated with acute bacterial replication and long-term persistence 8.
- Immune modulation and resistance to immune clearance can also contribute to persistent, non-healing wounds 8.
Future Directions
- Further studies are needed to determine the effectiveness of combination therapy and the optimal duration of antibiotic treatment for Enterococcus faecalis wound infections 5, 6, 7.
- The development of new antibiotics and antimicrobial strategies is crucial to combat the emergence of antibiotic-resistant Enterococcus faecalis strains 5, 4.