From the Guidelines
Enterococcus faecalis is a significant cause of serious infections, including endocarditis, bacteremia, and urinary tract infections, and its treatment typically involves antibiotics such as ampicillin or vancomycin, with combination therapy with an aminoglycoside needed for severe infections like endocarditis. The most recent and highest quality study, 1, recommends high-dose daptomycin (8-12 mg/kg daily) for the treatment of vancomycin-resistant Enterococcus bloodstream infections. Some key points to consider in the management of E. faecalis infections include:
- The use of ampicillin or vancomycin as first-line therapy, with combination therapy with an aminoglycoside for severe infections 1
- The importance of culture and susceptibility testing to guide antibiotic selection, particularly in cases of vancomycin-resistant E. faecalis 1
- The potential use of alternative antibiotics, such as linezolid or daptomycin, in cases of vancomycin-resistant E. faecalis 1
- The need for proper infection control measures, including hand hygiene and contact precautions, to prevent the spread of E. faecalis in healthcare settings 1 Overall, the management of E. faecalis infections requires a comprehensive approach that takes into account the severity of the infection, the susceptibility of the organism to antibiotics, and the need for proper infection control measures.
From the Research
Significance of Enterococcus faecalis Infection
- Enterococcus faecalis (E. faecalis) is a significant pathogen that can cause various infections, including urinary tract, intra-abdominal, central nervous system, and bloodstream infections 2.
- E. faecalis is the third most common causal agent of infective endocarditis, and its treatment can be challenging due to its resistance to several antibiotics 3.
- The risk factors for colonization and infection with E. faecalis include prior treatment with antibiotics such as cephalosporins or quinolones, and the use of glycopeptides may be necessary for empiric treatment of severe infections 4.
Clinical Implications
- E. faecalis infections can have a significant impact on patient outcomes, particularly in nosocomial settings, and can be associated with high morbidity and mortality 5.
- The management of E. faecalis bacteremia poses a challenge for clinicians and microbiologists, and requires a multidisciplinary approach due to the complexity and severity of the infection 5.
- The use of antibiotics such as ampicillin, ceftriaxone, daptomycin, and linezolid may be effective against E. faecalis infections, but the emergence of resistance is a concern 2, 3, 6.
Treatment Options
- Combination therapy with ampicillin and ceftriaxone may be effective for the treatment of E. faecalis infective endocarditis, and can be administered in an outpatient setting 3.
- Daptomycin and linezolid have demonstrated clinical efficacy against vancomycin-resistant E. faecalis, and may be used as alternative treatment options 2, 6.
- The use of synergistic combinations of antibiotics may be warranted in complex infections, while monotherapies may be sufficient for uncomplicated infections 2.