From the Guidelines
For treating urinary tract infections (UTI) caused by Enterococcus faecium, the recommended treatment is a single dose of fosfomycin 3 g PO, which is a weak recommendation with very low quality of evidence 1.
Treatment Options
- Fosfomycin 3 g PO as a single dose is recommended for uncomplicated urinary tract infections due to VRE, with a weak recommendation and very low quality of evidence 1.
- Nitrofurantoin 100 mg PO every 6 h is also recommended for uncomplicated urinary tract infections due to VRE, with a weak recommendation and very low quality of evidence 1.
- High dose ampicillin (18-30 g IV daily in divided doses) or amoxicillin 500 mg IV or PO every 8 h daily may be considered for uncomplicated urinary tract infections due to VRE, with a weak recommendation and very low quality of evidence 1.
Considerations
- Treatment should be guided by antimicrobial susceptibility testing due to E. faecium's increasing resistance patterns.
- Patients should complete the full course of antibiotics even if symptoms improve, drink plenty of water to help flush bacteria from the urinary tract, and follow up with their healthcare provider if symptoms persist or worsen.
- E. faecium is particularly challenging to treat because it has intrinsic resistance to many antibiotics and can acquire additional resistance mechanisms, making susceptibility testing crucial for effective treatment.
Complicated or Resistant Infections
- For complicated or resistant infections, linezolid 600 mg IV or PO every 12 h may be necessary, with a strong recommendation and low quality of evidence 1.
- High dose daptomycin 8-12 mg/kg IV daily or in combination with beta-lactams may also be considered for VRE bacteremia, with a weak recommendation and low quality of evidence 1.
From the Research
Treatment Options for Urinary Tract Infection (UTI) caused by Enterococcus faecium
- The treatment of UTIs caused by Enterococcus faecium can be challenging due to the presence of multidrug-resistant strains 2.
- For uncomplicated UTIs, potential oral agents active against Enterococcus faecium include nitrofurantoin, fosfomycin, and linezolid 3, 2, 4.
- Linezolid has demonstrated clinical efficacy against vancomycin-resistant Enterococcus faecium and is considered a reliable oral antimicrobial option 4, 5.
- Parenteral agents such as daptomycin and quinupristin-dalfopristin may be considered for the treatment of pyelonephritis and complicated UTIs caused by Enterococcus faecium 3, 2.
- Aminoglycosides or rifampin may be considered as adjunctive therapy in serious infections 2.
Antibiotic Resistance and Treatment
- Vancomycin-resistant Enterococcus faecium isolates are often susceptible to linezolid, but may be resistant to other antibiotics such as ampicillin, ciprofloxacin, and nitrofurantoin 4.
- The use of synergistic combinations of antibiotics may be warranted in complex infections, while monotherapies may be appropriate for uncomplicated infections 3.