Vancomycin-resistant Enterococcus infective endocarditis: A case series and review of the literature

To describe the epidemiology, management and clinical outcomes of patients with VRE infective endocarditis.

We performed a retrospective review of VRE infective endocarditis cases from our institution and the published literature between 2000 and 2024. Predictors of mortality were assessed using univariate and multivariate logistic regression.

A total of 72 cases were identified (18 local and 54 from the literature) from nine countries. Median age was 60.0 years (IQR: 44.0-69.0), with 64.8% of cases being male. Enterococcus faecium was the most common species (64/72, 88.9%). Presence of a central venous catheter (25/72, 34.7%), requiring haemodialysis (19/72, 26.4%) and underlying diabetes (18/72, 25.0%) were the most commonly reported comorbidities associated with endocarditis. Native cardiac valves were most commonly affected (n = 47/72, 65.3%), with surgical intervention uncommon (21.2%). Nineteen patients (26.4%) were treated with monotherapy, with the remaining 53 patients receiving sequential therapy using 30 different antibiotic combinations. Median treatment duration was 50.0 days (IQR: 31.0-58.0) and the end-of-treatment mortality was 40.8% (n = 29/71). There were no independent predictors of mortality identified.

VRE endocarditis is an uncommon infection with high mortality. We highlight the diversity in antimicrobial management and importance of further research into this challenging infection.