From the Guidelines
Enterococcus bacteremia should be managed with linezolid 600 mg IV or PO every 12 hours, as recommended by the most recent guidelines 1.
Treatment Approach
The treatment approach for Enterococcus bacteremia depends on the susceptibility of the strain and the severity of the infection.
- For ampicillin-susceptible strains, ampicillin 2g IV every 4 hours is recommended.
- For ampicillin-resistant strains, vancomycin 15-20 mg/kg IV every 8-12 hours is recommended.
- In severe cases or endocarditis, combination therapy with an aminoglycoside (gentamicin 1 mg/kg IV every 8 hours) should be added for synergistic effect.
Duration of Treatment
The duration of treatment is typically 10-14 days for uncomplicated bacteremia, but extends to 4-6 weeks for endocarditis or when there's a deep-seated infection.
Source Control
Source control is crucial, so any infected catheters should be removed and abscesses drained.
Resistance Patterns
Resistance patterns vary significantly, with vancomycin-resistant enterococci (VRE) requiring treatment with linezolid 600mg IV/PO every 12 hours or daptomycin 8-12 mg/kg IV daily, as recommended by recent guidelines 1.
Recent Guidelines
Recent guidelines recommend linezolid 600 mg IV or PO every 12 hours for enterococcal infections, with the treatment duration dependent on the site of infection and clinical response 1.
Key Considerations
Key considerations in the management of Enterococcus bacteremia include:
- Identifying the susceptibility of the strain to guide treatment
- Using combination therapy in severe cases or endocarditis
- Ensuring source control through removal of infected catheters and drainage of abscesses
- Monitoring for resistance patterns and adjusting treatment accordingly
- Following recent guidelines for treatment recommendations, such as those outlined in 1 and supported by earlier studies 1.
From the FDA Drug Label
Vancomycin-Resistant Enterococcus faecium infections, including cases with concurrent bacteremia The management of Enterococcus bacteremia includes the use of linezolid, as it is indicated for the treatment of Vancomycin-Resistant Enterococcus faecium infections, including cases with concurrent bacteremia 2.
- The treatment should be guided by culture and susceptibility information when available.
- In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.
- It is essential to initiate specific therapy immediately if a concomitant Gram-negative pathogen is documented or suspected.
From the Research
Management of Enterococcus Bacteremia
The management of Enterococcus bacteremia poses a challenge for clinicians and microbiologists due to its complexity and severity 3. The following are key aspects of its management:
- Epidemiological, clinical, and microbiological characteristics and factors associated with prognosis of Enterococcus bacteremia are crucial in its management 3.
- Diagnosis and work-up, including the use of echocardiography to rule out endocarditis, are essential in the management of Enterococcus bacteremia 3.
- Antibiotic management with special focus on antimicrobial resistance and complicated Enterococcus bacteremia is critical in its treatment 3, 4, 5.
Antibiotic Treatment
The choice of antibiotic treatment for Enterococcus bacteremia depends on various factors, including the severity of the infection, the presence of antimicrobial resistance, and the patient's underlying conditions.
- High-dose daptomycin is considered effective in the treatment of Enterococcus bloodstream infection and endocarditis, although published clinical experience with the latter condition is limited 4.
- Linezolid and daptomycin are primary treatment options for vancomycin-resistant Enterococcus bacteremia, although definitive clinical data to assess comparative therapeutic effectiveness are lacking 5, 6.
- Studies have shown that linezolid may be associated with better outcomes compared to daptomycin in the treatment of vancomycin-resistant Enterococcus bacteremia 5.
- However, another study found no differences in microbiological cure, length of stay, or mortality between linezolid and daptomycin-treated patients with vancomycin-resistant Enterococcus bacteremia 6.
Multidisciplinary Approaches
Multidisciplinary approaches, including infectious disease consultation and the use of bundles, are warranted due to the complexity and severity of Enterococcus bacteremia 3.
- Early alert systems and rapid diagnostic techniques, such as matrix-assisted desorption ionization-time of flight mass spectrometry, can improve management and prognosis of Enterococcus bacteremia 3.
- Echocardiography is also key in the work-up of Enterococcus bacteremia and should probably be more extensively used, although its exact indications in Enterococcus bacteremia are still debated 3.