Can be contaminants.
Draw repeat cultures to confirm before starting treatment.
In 2016, the majority (81%) of E. faecium blood isolates at UCLA are resistant to vancomycin (VRE).
If the isolate happens to be susceptible to ampicillin or vancomycin, these agents should
be used preferentially.
Linezolid 600mg IV/PO q12h
Daptomycin 6mg/kg IV q24h
Requires ID consult or ASP approval
Quinupristin/dalfopristin 7.5mg/kg q8h
Effective against E. faecium only.
Do not use without ID input.
Ampicillin 2g IV q4h
WITH OR WITHOUT
Gentamicin 1mg/kg IV q8h
See Treatment Notes below
Vancomycin (Dosing per pharmacy)
Consider echocardiogram if there is persistent bacteremia >3 days on appropriate antibiotics, especially if the bacteremia was community-acquired.
Do not use gentamicin if the lab reports no synergy with gentamicin; doing so increases the risk of nephrotoxicity without clinical benefit.
If synergy is present, gentamicin must be added to ampicillin or vancomycin for the treatment of endocarditis; however the addition of gentamicin does not appear to change
outcomes in CLABSI due to Enterococcus in the absence of endocarditis if the catheter has been removed.
When used for synergy, conventional dosing of aminoglycosides is preferred to extended-interval (once-daily) dosing. Specify synergy dosing during ordering
Do not use gentamicin with linezolid or quinupristin/dalfopristin given the lack of supportive evidence for synergy.
Enterococcal endocarditis should not be treated with monotherapy. Infectious Disease consultation is strongly recommended for all cases of Enterococcal endocarditis.