Treatment of Enterococcus Bacteremia

Initial Antimicrobial Therapy

For ampicillin-susceptible Enterococcus faecalis, ampicillin is the preferred first-line treatment, as recommended by the Infectious Diseases Society of America 1
For ampicillin-resistant strains, vancomycin is the recommended alternative, according to the Infectious Diseases Society of America 1, 2
For both ampicillin and vancomycin-resistant enterococci, linezolid or daptomycin should be used based on susceptibility testing, as suggested by the Infectious Diseases Society of America 1

For uncomplicated enterococcal bacteremia, a 7-14 day course of therapy is recommended when the catheter is removed or when a long-term catheter is retained and antibiotic lock therapy is used, as recommended by the Infectious Diseases Society of America 1, 2
For complicated enterococcal bacteremia, longer treatment courses are required for endocarditis or metastatic infections, according to the Infectious Diseases Society of America 1

Short-term intravascular catheters should be removed when infected with enterococci, as recommended by the Infectious Diseases Society of America 1
Long-term catheters should be removed in cases of insertion site or pocket infection, suppurative thrombophlebitis, or sepsis, according to the Infectious Diseases Society of America 2, 4
If a long-term catheter is retained, antibiotic lock therapy should be used in addition to systemic therapy, as suggested by the Infectious Diseases Society of America 1

Empiric anti-enterococcal therapy is recommended for healthcare-associated infections, particularly in immunocompromised patients or patients with valvular heart disease, according to the Infectious Diseases Society of America 4
Enterococcal bacteremia that persists for >4 days has been independently associated with increased mortality, as reported by the Infectious Diseases Society of America 2

Inadequate treatment duration, especially in cases with endovascular infection, should be avoided, as recommended by the Infectious Diseases Society of America 1
Failure to remove infected catheters when indicated should be avoided, according to the Infectious Diseases Society of America 1
Not performing transesophageal echocardiography (TEE) when indicated, potentially missing endocarditis, should be avoided, as recommended by the Infectious Diseases Society of America 1, 2