What is the treatment for Enterococcus faecalis (E. faecalis) bacteremia?

From the Guidelines

Enterococcus faecalis bacteremia should be treated with intravenous ampicillin 2g every 4 hours, often combined with gentamicin 1mg/kg every 8 hours for synergistic effect in severe infections, as recommended by the American Heart Association 1.

Treatment Considerations

• For penicillin-allergic patients, vancomycin 15-20mg/kg every 8-12 hours (not to exceed 2g per dose) is the preferred alternative.
• Treatment duration typically ranges from 10-14 days for uncomplicated bacteremia to 4-6 weeks for endocarditis or other complicated infections.
• Blood cultures should be repeated to confirm clearance of the bacteremia.
• Source control is essential, requiring removal of infected catheters or drainage of abscesses when present.

Resistant Organisms

• For vancomycin-resistant E. faecalis (VRE), linezolid 600mg IV/oral twice daily or daptomycin 8-10mg/kg once daily may be used, as suggested by the Infectious Diseases Society of America 1.
• Susceptibility testing is crucial as E. faecalis can develop resistance to multiple antibiotics.

Special Considerations

• Consultation with infectious disease specialists is recommended for complicated cases, especially those involving endocarditis, immunocompromised patients, or resistant organisms.
• E. faecalis bacteremia requires aggressive treatment because this gram-positive organism can cause serious complications including endocarditis and has intrinsic resistance to many antibiotics due to its cell wall structure and efflux pump mechanisms. Some key points to consider in the treatment of Enterococcus faecalis bacteremia include:
• The use of combination therapy with a cell wall-active antimicrobial and an aminoglycoside may be beneficial in certain cases, such as in patients with severe infections or those who are at high risk of complications 1.
• The duration of treatment should be individualized based on the severity of the infection, the presence of complications, and the patient's response to therapy.
• The use of antibiotic lock therapy may be beneficial in patients with catheter-related bloodstream infections, as it can help to prevent the development of resistance and reduce the risk of complications 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)

The treatment for Enterococcus faecalis bacteremia is daptomycin, but only for vancomycin-susceptible isolates. The dosage is not specified in the provided text for this particular condition, but it is essential to consult the FDA-approved labeling for the recommended dosage. 2, 2, and 2 provide information on daptomycin's efficacy against Gram-positive bacteria, including Enterococcus faecalis. However, the specific dosage for treating Enterococcus faecalis bacteremia is not mentioned in the given text. It is crucial to follow the recommended dosage and treatment guidelines for the specific condition being treated.

From the Research

Leuconostoc Bacteremia Treatment

The treatment of Leuconostoc bacteremia is primarily focused on the use of antibiotics and the removal of infected intravascular catheters.

• The use of high-dose penicillin, clindamycin, and other beta-lactams has been reported as effective in treating Leuconostoc bacteremia 3, 4, 5.
• Catheter removal is also a crucial step in the treatment of catheter-related Leuconostoc bacteremia, as it helps to eliminate the source of infection 3, 4, 5.
• In some cases, the use of tigecycline has been reported as a successful treatment option for Leuconostoc bacteremia, particularly in patients with limited treatment options due to antibiotic resistance 6.
• It is essential to note that Leuconostoc species are naturally resistant to vancomycin, which is a commonly used antibiotic for treating gram-positive bacterial infections 3, 4, 5.

Risk Factors and Clinical Presentation

Leuconostoc bacteremia is often associated with certain risk factors, including:

• Immunocompromised state, such as cancer or neutropenia 5, 6
• Previous glycopeptide therapy, such as vancomycin 5
• Use of parenteral nutrition 5
• Disruption of skin barrier and gastrointestinal conditions 5
• The clinical presentation of Leuconostoc bacteremia may include fever, leukocytosis, and gastrointestinal complaints 3, 4.

Diagnosis and Susceptibility Testing

• The diagnosis of Leuconostoc bacteremia is often made through blood culture specimens, and it is essential to identify the species and perform susceptibility testing to guide treatment 3, 4, 5.
• Leuconostoc species are often misidentified as viridans streptococci, highlighting the importance of accurate identification and susceptibility testing 3.