Treatment of Enterococcus faecalis Infective Endocarditis: A Continuing Challenge

Abstract

Today, Enterococcus faecalis is one of the main causes of infective endocarditis in the world, generally affecting an elderly and fragile population, with a high mortality rate. Enterococci are partially resistant to many commonly used antimicrobial agents such as penicillin and ampicillin, as well as high-level resistance to most cephalosporins and sometimes carbapenems, because of low-affinity penicillin-binding proteins, that lead to an unacceptable number of therapeutic failures with monotherapy. For many years, the synergistic combination of penicillins and aminoglycosides has been the cornerstone of treatment, but the emergence of strains with high resistance to aminoglycosides led to the search for new alternatives, like dual beta-lactam therapy. The development of multi-drug resistant strains of Enterococcus faecium is a matter of considerable concern due to its probable spread to E. faecalis and have necessitated the search of new guidelines with the combination of daptomycin, fosfomycin or tigecycline. Some of them have scarce clinical experience and others are still under investigation and will be analyzed in this review. In addition, the need for prolonged treatment (6–8 weeks) to avoid relapses has forced to the consideration of other viable options as outpatient parenteral strategies, long-acting administrations with the new lipoglycopeptides (dalbavancin or oritavancin), and sequential oral treatments, which will also be discussed.

Enterococcal Faecalis Endocarditis in Renal Transplant Patients: Our Experience with Ampicillin and Daptomycin Combination

“…We have summarized the clinical features, renal status, and outcome in Table 2, including our case report. The findings of Pericas et al [3] and Herrera-Hidalgos et al [27] contemporary reviews align with our data presented in Table 2. They demonstrate that Enterococcal endocarditis is the second most prevalent cause of infective endocarditis within the chronic hemodialysis population, trailing behind only Staphylococcus aureus with percentages of 15.4% and 47.8%, respectively.…”

Investigation of some changes and clonal relationship in enterococci isolates due to relocation of a hospital

“…However, ampicillin and vancomycin resistance necessitates the use of other antibiotics. 22 In the current study, significant ampicillin resistance rate was found for E. faecium strains. However, no significant difference was detected in terms of the resistance against ampicillin.…”

Ampicillin Stability in a Portable Elastomeric Infusion Pump: A Step Forward in Outpatient Parenteral Antimicrobial Therapy

“…Following this therapeutic regimen, EIPs could be prepared and dispensed twice a week, favoring their transfer for use in OPAT for the treatment of infections such as endocarditis or osteomyelitis. In the case of endocarditis, these results are particularly relevant since they position the dual therapy of AMP and ceftriaxone for its use in OPAT against other novel and more expensive antibiotics with promising characteristics like teicoplanin or dalbavancin, whose usefulness in the outpatient management of infective endocarditis caused by Enterococcus faecalis is still not sufficiently justified to make a new recommendation or to implement a safe and effective outpatient treatment protocol [ 45 , 49 , 50 , 51 ].…”