Ampicillin-resistant and vancomycin-susceptible Enterococcus faecium bacteremia: a clinical narrative review

Abstract

Article highlights-Incidence of infections caused by Enterococcus faecium is increasing, especially bacteremia, which is related to high morbidity and mortality. -Although E. faecalis bacteremia has been historically predominant, E. faecium has become more prevalent. This finding raises concerns, as E. faecium bacteremia exhibits higher mortality. -Several reasons may explain this increase:o Both its extraordinary ability to survive hostile environments and its antibiotic resistance, which confers an important selective advantage. o A rise in the number of patients with risk factors and antibiotic pressure, which predisposes them to infection. -Risk factors are well-known: comorbidities (advanced age, diabetes, immunosuppression); admission to ICU; broad-spectrum antibiotics (especially third generation cephalosporins and carbapenems); prolonged hospital stay or the use of urinary/vascular catheters. -Mortality remains high, although it is uncertain whether it is attributable to either the infection or a marker of severity/comorbidities. -Ampicillin-resistant and vancomycin-susceptible E. faecium is considered a difficult-to-treat microorganism. Physicians face the challenge of balancing varying considerations, including patients' comorbidities, infection severity and the high propensity for antibiotic-related toxicities. -Glycopeptides, linezolid and daptomycin remain the most employed antibiotic agents.-Clinical evidence is scarce and low-quality. Glycopeptides and linezolid are first-line agents. The use of daptomycin is controversial due to concerns of a higher risk of treatment failure. -Other significant aspects remain unresolved, including the importance of appropriate empiric treatment, length of treatment and oral switch. -Randomized controlled clinical trials are needed to determine the most appropriate treatment.

Bioactivity-Based Molecular Networking-Guided Isolation of Epicolidines A–C from the Endophytic Fungus Epicoccum sp. 1-042

“…2 The prevalence of vancomycin-resistant E. faecium (VRE) has rapidly increased over the past decade, particularly VRE bloodstream infections, which are correlated with notable morbidity and mortality, with mortality rates ranging from 20% to 50%. 3,4 Given the increasing prevalence of VRE and the continuous emergence of new variants, there is an acute necessity to explore novel antibiotics.…”

“…Enterococcus faecium , deemed a high-priority pathogen by the WHO, exhibits resistance to multiple antibiotics including fluoroquinolones, vancomycin, penicillins, and other antibiotics . The prevalence of vancomycin-resistant E. faecium (VRE) has rapidly increased over the past decade, particularly VRE bloodstream infections, which are correlated with notable morbidity and mortality, with mortality rates ranging from 20% to 50%. , Given the increasing prevalence of VRE and the continuous emergence of new variants, there is an acute necessity to explore novel antibiotics.…”