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Updated: Mar 20, 2026
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Antimicrobial Synergy Testing by the Inkjet Printer-assisted Automated Checkerboard Array and the Manual Time-kill Method
Published on: April 18, 2019
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Monotherapy vs. combination therapy for Enterococcus faecalis bacteraemia: a target trial emulation.
Michele Bartoletti1, Elena Rosselli Del Turco2, Linda Bussini1
1Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Infectious Diseases Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
Summary
Combination therapy did not show better outcomes than monotherapy for Enterococcus faecalis bloodstream infections (EF-BSI). These findings support simplifying treatment strategies, aligning with antimicrobial stewardship principles.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Pharmacology
Background:
- Enterococcus faecalis bloodstream infection (EF-BSI) treatment is debated.
- Optimal strategy for EF-BSI without endocarditis is unclear.
Purpose of the Study:
- To compare the effectiveness of combination therapy versus monotherapy for EF-BSI in patients without endocarditis.
Main Methods:
- Target trial emulation using a prospective, international dataset (2019-2024).
- Included adult patients with monomicrobial EF-BSI and negative echocardiography.
- Primary endpoint: clinical failure (death, relapse, or endocarditis diagnosis) at 90 days.
Main Results:
- 373 patients analyzed; 71% received monotherapy (mainly ampicillin).
- Clinical failure occurred in 28% of monotherapy vs. 36% of combination therapy patients (p=0.185).
- Sepsis or septic shock was the only independent predictor of clinical failure.
Conclusions:
- No significant difference in clinical failure between monotherapy and combination therapy for EF-BSI.
- Results suggest potential for therapeutic simplification in EF-BSI treatment.
- Findings support antimicrobial stewardship principles by potentially simplifying treatment regimens.
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