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Ampicillin-resistant and vancomycin-susceptible
Daniel Echeverria-Esnal1,2, Luisa Sorli2,3,4, María Eugenia Navarrete-Rouco1
1Department of Pharmacy, Hospital Del Mar, Parc de Salut Mar, Barcelona, Spain.
Introduction:
Enterococcus faecium is a commensal microorganism that can cause infections such as bacteremia. Incidence of ampicillin-resistant and vancomycin-susceptible E. faecium (EfARSV) bacteremia is on the rise, and the mortality rate is high. Despite much data, the most appropriate treatment remains a question.
Areas Covered:
This article mostly reviews the relevant aspects of EfARSV bacteremia: microbiology, gastrointestinal tract colonization and invasion, antibiotic resistance, epidemiology, risk factors, mortality, and treatment, including pharmacologic components of employed agents and related clinical evidence. A literature search was conducted on PubMed on 31 July 2022, which was updated on 15 November 2022.
Expert Opinion:
EfARSV bacteremia presents high mortality. However, it is uncertain whether mortality is attributable to or a marker of severity/comorbidities. Considering its antibiotic resistance pattern, EfARSV is considered a difficult-to-treat microorganism. Glycopeptides have been used to treat EfARSV, with linezolid and daptomycin serving as potential alternative agents. Yet, the use of daptomycin is controversial due to a higher risk of treatment failures. Clinical evidence on this issue is scarce, unfortunately, and subject to many limitations. Despite increased incidence and mortality, EfARSV bacteremia presents multiple aspects to be addressed in well-conducted studies.
Insights
Ampicillin-resistant and vancomycin-susceptible Enterococcus faecium (EfARSV) bacteremia is increasing and has high mortality. Optimal treatment for this difficult-to-treat infection remains unclear, requiring further research.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Clinical Pharmacy
Background:
- Enterococcus faecium is a common bacterium that can cause serious infections like bacteremia.
- Ampicillin-resistant and vancomycin-susceptible E. faecium (EfARSV) bacteremia is a growing concern with a high mortality rate.
- The optimal treatment strategy for EfARSV bacteremia is not well-established.
Purpose of the Study:
- To review the key aspects of EfARSV bacteremia.
- To discuss current treatment options and their limitations.
- To highlight the need for further research.
Main Methods:
- Comprehensive literature search on PubMed.
- Inclusion of studies published up to November 15, 2022.
- Review focused on microbiology, resistance, epidemiology, and treatment.
Main Results:
- EfARSV bacteremia is associated with high mortality, though causality is debated.
- EfARSV is a difficult-to-treat pathogen due to its resistance patterns.
- Glycopeptides, linezolid, and daptomycin are treatment options, but daptomycin use is controversial.
Conclusions:
- Despite increased incidence and mortality, EfARSV bacteremia requires more rigorous studies.
- Current clinical evidence on treatment is limited and has significant limitations.
- Further well-designed studies are essential to guide effective treatment strategies.
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