Enterococcus faecium

Enterococcus faecium is a gram positive bacterium in the genus Enterococcus. It can be a commensal (a non-harmful coexistence), in the human intestine, but it may also be a pathogen causing disease. Antibiotic resistant Enterococcus faecium is often referred to as 'VRE', Vancomycin-Resistant Enterococcus.

Antimicrobial regimen

• Enterococcus faecium

• 1.Bacteremia

• Ampicillin or Penicillin susceptible : Ampicillin 2 g IV q4-6h OR (Ampicillin AND Gentamicin 1 mg/kg q8h).
• Ampicillin resistant and vancomycin susceptible or Penicillin allergy : (Vancomycin 15 mg/kg IV q12h AND Gentamicin 1 mg/kg q8h) OR Linezolid 600 mg q12h OR Daptomycin 6 mg/kg per day.
• Ampicillin and Vancomycin resistant : Linezolid 600 mg q12h OR Daptomycin 6 mg/kg IV per day

• 2.Endocarditis

• 2.1.Endocarditis in Adults

• Strains Susceptible to Penicillin, Gentamicin, and Vancomycin

• Preferred regimen : (Ampicillin 12 g/day IV for 4–6weeks OR Aqueous crystalline penicillin G sodium 18–30 MU/day IV for 4–6weeks) AND Gentamicin sulfate 3 mg/kg/day IV/IM for 4–6 weeks
• Note : In case of native valve endocarditis, 4-wk therapy recommended for patients with symptoms of illness ≤3 months and 6-wk therapy recommended for patients with symptoms >3 months and prosthetic valve or other prosthetic cardiac material a minimum of 6 wk of therapy recommended
• Alternate regimen : Vancomycin hydrochloride 30 mg/kg/day IV for 6 weeks AND Gentamicin sulfate 3 mg/kg/day IV/IM for 6weeks

• Strains Susceptible to Penicillin, Streptomycin, and Vancomycin and Resistant to Gentamicin

• Preferred regimen : (Ampicillin 12 g/day IV for 4–6 weeks OR Aqueous crystalline penicillin G sodium 24 MU/day IV for 4–6weeks)AND Streptomycin sulfate 15 mg/kg/day IV/IM for 4–6weeks
• Alternate regimen: Vancomycin hydrochloride 30 mg/kg/day IV 6weeks AND Streptomycin sulfate 15 mg/kg per 24 h IV/IM for 6weeks

• Strains Resistant to Penicillin and Susceptible to Aminoglycoside and Vancomycin

• β Lactamase–producing strain
• Preferred regimen : Ampicillin-sulbactam 12 g/day IV for 6weeks AND Gentamicin sulfate 3 mg/kg/day IV/IM 6weeks
• Alternate regimen : Vancomycin hydrochloride 30 mg/kg/day IV for 6weeks AND Gentamicin sulfate 3 mg/kg/day IV/IM for 6weeks
• Intrinsic penicillin resistance : Vancomycin hydrochloride 30 mg/kg/day IV for 6weeks AND Gentamicin sulfate 3 mg/kg/day IV/IM for 6weeks

• Strains Resistant to Penicillin, Aminoglycoside, and Vancomycin

• Preferred regimen : Linezolid 1200 mg/day IV/PO ≥8weeks OR Quinupristin-Dalfopristin22.5 mg/kg/day IV ≥8weeks

• 2.2.Endocarditis in Pediatrics

• Strains Susceptible to Penicillin, Gentamicin, and Vancomycin

• Preferred regimen : (Ampicillin 300 mg/kg/day IV for 4–6 weeks OR Penicillin 300,000U/kg/day IV for 4–6 weeks) AND Gentamicin 3 mg/kg per 24 h IV/IM 4–6 weeks
• Note : In case of native valve endocarditis, 4-wk therapy recommended for patients with symptoms of illness ≤3 months and 6-wk therapy recommended for patients with symptoms >3 months and prosthetic valve or other prosthetic cardiac material a minimum of 6 wk of therapy recommended
• Alternate regimen : Vancomycin 40 mg/kg/day IV for 6weeks AND Gentamicin 3 mg/kg/day IV/IM for 6weeks

• Strains Susceptible to Penicillin, Streptomycin, and Vancomycin and Resistant to Gentamicin

• Preferred regimen : (Ampicillin 300 mg/kg/day IV for 4–6 weeks OR Penicillin 300,000 U/kg/day IV for 4–6 weeks) AND Streptomycin 20–30 mg/kg/day IV/IM for 4–6 weeks
• Alternate regimen: Vancomycin hydrochloride 40 mg/kg/day IV for 6weeks AND Streptomycin sulfate 15 mg/kg/day IV/IM for 6weeks

• Strains Resistant to Penicillin and Susceptible to Aminoglycoside and Vancomycin

• β Lactamase–producing strain
• Preferred regimen : Ampicillin-sulbactam 300 mg/kg/day IV for 6weeks AND Gentamicin 3 mg/kg/day IV/IM for 6weeks
• Alternate regimen : Vancomycin 40 mg/kg/day IV for 6weeks AND Gentamicin 3 mg/kg/day IV/IM for 6weeks
• Intrinsic penicillin resistance : Vancomycin 40 mg/kg/day IV AND Gentamicin 3 mg/kg/day IV/IM for 6weeks

• Strains Resistant to Penicillin, Aminoglycoside, and Vancomycin

• Preferred regimen : Linezolid 30 mg/kg/day IV/PO ≥ 8weeks OR Quinupristin-Dalfopristin22.5 mg/kg/day IV ≥ 8weeks

• 3.Meningitis

• Ampicillin susceptible

• Preferred regimen: Ampicillin 12 g/day IV q4h AND Gentamicin 5 mg/kg/day IV q8h

• Ampicillin resistant

• Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h AND Gentamicin 5 mg/kg/day IV q8h

• Ampicillin and vancomycin resistant

• Preferred regimen: Linezolid 600 mg IV q12h

• 4.Urinary tract infections

• Preferred regimen : Nitrofurantoin 100 mg PO q6h for 5 days OR Fosfomycin 3 g PO single dose OR Amoxicillin 875 mg-1 g PO q12h for 5 days

• 5.Intra abdominal or Wound infections

• Penicillin or Ampicillin are preferred agents, Vancomycin in setting of penicillin allergy or high-level penicillin resistance.
• For complicated skin-skin structure and intra-abdominal infection : Tigecycline 100 mg IV single dose and 50 mg IV q12h