Treatment for Bacteremia Caused by Vancomycin-Resistant Enterococcus faecalis

First-Line Treatment Options

The Infectious Diseases Society of America recommends linezolid 600 mg IV or PO every 12 hours as the first-line treatment for bacteremia caused by vancomycin-resistant Enterococcus faecalis, with high-dose daptomycin (8-12 mg/kg/day) being an effective alternative, especially at doses ≥9 mg/kg 1, 2, 3
Linezolid has demonstrated clinical efficacy with overall microbiological and clinical cure rates of 86.4% and 81.4%, respectively 3, 4
High-dose daptomycin is recommended at doses of 8-12 mg/kg/day for VRE bacteremia (weak recommendation, low quality of evidence) 1, 2

Meta-analyses comparing linezolid and daptomycin have shown conflicting results 5
Microbiological cure rates are comparable between daptomycin and linezolid (93% vs. 91%) 3, 5

Daptomycin combined with β-lactams has shown improved outcomes in some studies 5, 6
Combinations with non-β-lactams (gentamicin, linezolid, rifampin, tigecycline) have been reported but require further study 6

For intra-abdominal infections due to VRE: Tigecycline 100 mg IV loading dose followed by 50 mg IV q12h 3, 6
For uncomplicated urinary tract infections due to VRE: Fosfomycin 3 g PO single dose 3, 7, Nitrofurantoin 100 mg PO every 6 hours 3, 7, or high-dose ampicillin (18-30 g IV daily in divided doses) or amoxicillin 500 mg PO/IV every 8 hours 3, 7

Failing to differentiate between colonization and true infection before initiating treatment 6
Not removing central venous catheters or other potential sources of persistent infection 6
Using tigecycline for VRE bacteremia (not recommended due to large volume of distribution and low serum levels) 6
Neglecting to implement appropriate infection control measures to prevent VRE transmission 6