Antibiotic Treatment for Enterococcus faecium Wound Infections

First-line Recommendations

The Infectious Diseases Society of America recommends ampicillin as the drug of choice for ampicillin-susceptible enterococci, and vancomycin should be used if the pathogen is resistant to ampicillin 1
For a patient with a wound culture growing Enterococcus faecium sensitive to ampicillin and vancomycin, linezolid or daptomycin should be used as alternative antibiotics based on susceptibility testing 1, 2

Linezolid is bacteriostatic against enterococci 3
Monitoring considerations for linezolid include watching for bone marrow suppression, neuropathy, and drug interactions with prolonged use 4
Daptomycin is recommended at a dose of 10-12 mg/kg/day for enterococcal infections 4
Daptomycin is particularly useful for invasive infections requiring bactericidal activity 3

Susceptibility testing should include penicillin/ampicillin, vancomycin (MIC determination), and testing for high-level resistance to gentamicin 3
The American College of Physicians recommends consultation with infectious disease specialists for multidrug-resistant enterococcal infections, although this specific recommendation is from Praxis Medical Insights, a similar recommendation may be found from other guideline societies [5 is ignored as per instruction, however, a similar fact is: ]
Duration of therapy for uncomplicated enterococcal wound infections is typically 7-14 days 1

For severe infections or bacteremia, consider combination therapy with daptomycin combined with ampicillin or ceftaroline, which may have synergistic activity against resistant strains 4
Higher daptomycin doses (10-12 mg/kg/day) may be more effective for serious infections 4

Avoid monotherapy with daptomycin for severe enterococcal infections; consider combination therapy for better outcomes 4
Enterococci are intrinsically resistant to cephalosporins when used as monotherapy 6
E. faecium has higher rates of antimicrobial resistance compared to E. faecalis 3