Enterococcus faecium

Precautions

Standard Precautions

General Information

First Line Treatment

Ampicillin-Sensitive

  • Ampicillin

  • Amoxicillin

  • Penicillin

Ampicillin-resistant, Vancomycin-sensitive

  • Vancomycin

  • Amoxicillin OK for urine isolates

VRE

  • Linezolid

  • Ampicillin or amoxicillin for uncomplicated cystitis

Add gentamicin or streptomycin when cidal activity is required (eg for endocarditis) and agents are susceptible for synergy

Alternate Treatment

Ampicillin-Sensitive

  • Vancomycin

  • Linezolid

  • Piperacillin/tazobactam

  • Daptomycin

  • Tigecycline

Ampicillin-resistant, Vancomycin-sensitive

  • Linezolid

  • Daptomycin

VRE

  • Daptomycin

  • Tigecycline

Add gentamicin or streptomycin when cidal activity is required (eg for endocarditis) and agents are susceptible for synergy

Pathogen information

Gram positive cocci in short chains

Epidemiology

Nosocomial (esp. VRE), associated with prior antibiotics

Associated syndromes

Colonization

More likely to cause true infection in immunocompromised or after selection pressure from antimicrobial administration has eliminated other organisms

Bacteremia, endocarditis (usually subacute), intra-abdominal or hepatobiliary infection, UTI

Additional Information

Most E. faecium will be VRE