From the Guidelines
Enterococcus faecalis infections should be treated with a combination therapy of penicillin G or ampicillin together with gentamicin for 4 to 6 weeks, as this regimen has been shown to be effective in treating enterococcal endocarditis 1. When treating Enterococcus faecalis infections, it is essential to consider the bacterium's intrinsic resistance to many antibiotics and its ability to acquire additional resistance mechanisms.
- E. faecalis commonly causes urinary tract infections, endocarditis, bacteremia, wound infections, and intra-abdominal infections.
- Treatment typically involves antibiotics such as ampicillin (2g IV every 4-6 hours) or vancomycin (15-20 mg/kg IV every 8-12 hours) for 7-14 days, depending on infection severity and site.
- For serious infections like endocarditis, combination therapy with an aminoglycoside (gentamicin 3 mg/kg/day) is often recommended for synergistic effects, typically for 4-6 weeks 1.
- E. faecalis presents treatment challenges due to its intrinsic resistance to many antibiotics and ability to acquire additional resistance mechanisms.
- It forms biofilms on medical devices and can survive harsh environmental conditions.
- Proper hand hygiene, contact precautions, and environmental cleaning are essential preventive measures in healthcare settings to limit its spread. In cases where the enterococcal strain is resistant to β-lactams, vancomycin, or aminoglycosides, it is reasonable to test for susceptibility in vitro to daptomycin and linezolid 1.
- Linezolid is bacteriostatic in vitro against enterococci, whereas daptomycin is bactericidal in vitro in susceptible strains.
- The combination of ampicillin plus ceftriaxone was reported to be effective for aminoglycoside nonsusceptible Enterococcus faecalis strains 1. Management of patients with enterococcal infections should always involve infectious disease consultation as the standard of care 1.
From the Research
Enterococcus faecalis Overview
- Enterococcus faecalis is a type of bacteria that can cause various infections, including nosocomial infections such as bacteremia, intra-abdominal infection, and endocarditis 2.
- It has intrinsic resistance to many antibiotics, making treatment challenging 2, 3.
Treatment Options
- Daptomycin has been shown to be effective against Enterococcus faecalis, particularly when combined with β-lactams 2.
- Linezolid and vancomycin are also potential treatment options, but their effectiveness can be limited by resistance 4, 3.
- Tigecycline has been shown to have activity against vancomycin-resistant Enterococcus faecalis, but resistance can still occur 3.
- Ampicillin can be effective against Enterococcus faecalis, but resistance is a concern 5, 6.
Resistance Patterns
- Enterococcus faecalis can develop resistance to various antibiotics, including daptomycin, linezolid, and vancomycin 3, 6.
- The use of daptomycin is controversial due to a higher risk of treatment failures 6.
- Resistance patterns can vary depending on the location and time of isolation 3, 5.
Clinical Implications
- Enterococcus faecalis bacteremia can have high mortality rates, particularly in cases of ampicillin-resistant and vancomycin-susceptible strains 6.
- Treatment of Enterococcus faecalis infections requires careful consideration of antibiotic resistance patterns and potential treatment failures 2, 6.
- Further research is needed to determine the best treatment options for Enterococcus faecalis infections and to address the rising incidence of antibiotic resistance 4, 6.