Antibiotic Therapy for Enterococcal Infections

Introduction to Enterococcal Coverage

Meropenem does not adequately cover Enterococcus faecalis and has no reliable activity against Enterococcus faecium, requiring additional antimicrobial coverage when treating infections where enterococci are suspected or confirmed pathogens 1

Empiric coverage of Enterococcus is not necessary for community-acquired infections, as recommended by the Infectious Diseases Society of America 2
Antimicrobial therapy for enterococci should be given when enterococci are recovered in healthcare-associated infections, as recommended by the Infectious Diseases Society of America 2
Empiric anti-enterococcal therapy is recommended for high-risk patients, including those with healthcare-associated infections, postoperative infections, prior cephalosporin exposure, immunocompromised patients, and patients with valvular heart disease or prosthetic intravascular materials, as recommended by the Infectious Diseases Society of America 2

Nosocomial infections, particularly postoperative infections, may require enterococcal coverage 1, 2
Severe healthcare-associated intra-abdominal infections, especially in immunocompromised patients, may require enterococcal coverage, as recommended by the Infectious Diseases Society of America 2
Patients with prior cephalosporin exposure are at higher risk of enterococcal infections and may require enterococcal coverage, as recommended by the Infectious Diseases Society of America 2
Positive cultures with enterococci recovered from clinical specimens may require enterococcal coverage, as recommended by the Infectious Diseases Society of America 2

Piperacillin-tazobactam has better enterococcal coverage than meropenem and may be considered as an alternative therapy, as recommended by the Infectious Diseases Society of America 2, 3
Addition of vancomycin to meropenem may be necessary when enterococcal coverage is needed, as recommended by the European Society of Clinical Microbiology and Infectious Diseases 1