Treatment of Enterococcus faecalis Catheter-Associated Bloodstream Infection
Initial Management
- The Infectious Diseases Society of America recommends removing infected short-term intravascular catheters 1
- For infected long-term catheters, removal is indicated in cases of insertion site or pocket infection, suppurative thrombophlebitis, sepsis, endocarditis, persistent bacteremia, or metastatic infection 2
Antimicrobial Therapy
- The American College of Clinical Pharmacy recommends ampicillin as the drug of choice for ampicillin-susceptible E. faecalis, with vancomycin reserved for ampicillin-resistant strains 1, 2
- For ampicillin and vancomycin-resistant E. faecalis, linezolid or daptomycin should be used based on susceptibility results 1, 2
Duration of Therapy
- The Infectious Diseases Society of America recommends 7-14 days of therapy for uncomplicated enterococcal CRBSI when the short-term catheter is removed or the long-term catheter is retained with antibiotic lock therapy 1, 2
- Extended therapy (4-6 weeks) is recommended for complicated cases with endocarditis, suppurative thrombophlebitis, or persistent bacteremia 2
Adjunctive Therapy
- The American College of Clinical Pharmacy recommends antibiotic lock therapy in addition to systemic therapy if the long-term catheter is retained 1, 2
Monitoring for Complications
- The Infectious Diseases Society of America recommends performing transesophageal echocardiography (TEE) if signs/symptoms suggest endocarditis, or if there is prolonged bacteremia or fever despite appropriate therapy 2
Role of Combination Therapy
- The Infectious Diseases Society of America notes that the role of combination therapy for enterococcal CRBSI without endocarditis remains unresolved, but some evidence suggests combination therapy with gentamicin and ampicillin may be more effective than monotherapy when the catheter is retained 1, 2