Treatment of Vancomycin-Resistant Enterococcus Bacteremia

Primary Treatment Options

• Daptomycin 6 mg/kg IV after each dialysis session is recommended for hemodialysis patients with VRE bacteremia, as per the Infectious Diseases Society of America 1
• The Infectious Diseases Society of America recommends daptomycin 8-10 mg/kg IV daily for non-dialysis patients with severe VRE bacteremia, given its bactericidal activity 1

Treatment Duration Based on Clinical Scenario

• For uncomplicated bacteremia, 14 days of therapy is recommended if source control is achieved and blood cultures clear within 72 hours, as per the Infectious Diseases Society of America 1
• The Infectious Diseases Society of America recommends 4-6 weeks of therapy for persistent bacteremia (>72 hours duration) after catheter removal 1
• For osteomyelitis complicating VRE bacteremia, the Infectious Diseases Society of America recommends 6-8 weeks of therapy 1
• The Infectious Diseases Society of America recommends 4-6 weeks minimum for endocarditis, with consideration for longer courses based on valve involvement 1

Source Control Considerations

• The Infectious Diseases Society of America recommends removing central venous catheters in patients with VRE bacteremia, particularly if symptoms persist beyond 2-3 days despite appropriate antibiotics 1
• For hemodialysis catheters, the Infectious Diseases Society of America recommends guidewire exchange if patient is asymptomatic and blood cultures clear within 2-3 days 1
• The Infectious Diseases Society of America recommends antibiotic lock therapy (10-14 days) as adjunctive therapy if catheter is retained in hemodialysis patients 1

Risk Stratification and Empirical Therapy Considerations

• Previous VRE colonization or infection is the strongest predictor of VRE bacteremia, as per the Infectious Diseases Society of America 2
• Treatment in hospitals with high VRE endemicity rates is a risk factor for VRE bacteremia, as per the Infectious Diseases Society of America 2
• The Infectious Diseases Society of America recommends adding linezolid or daptomycin empirically only when patient is unstable AND has documented VRE risk factors 2
• The Centers for Disease Control and Prevention recommends implementing strict contact precautions, hand hygiene, and environmental cleaning to prevent VRE transmission 4