Clinical Features and Real-World Management of Enterococcus faecium Infective Endocarditis: A Nationwide Multicenter...

Enterococcus faecium infective endocarditis (IE) is uncommon, therapeutically challenging, and poorly characterized. We aimed to define its clinical phenotype, outcomes, and treatment patterns.

We performed a prospective multicenter observational study using the Spanish GAMES registry. Episodes of E. faecium IE diagnosed from 2008 through 2024 were compared with IE caused by other etiologies.

Among 7014 episodes of IE, 71 (1.0%) were caused by E. faecium. Compared with other etiologies, patients with E. faecium IE were older, had a greater comorbidity burden, and more often had nosocomial acquisition. This syndrome more frequently involved native valves and was associated with more acute kidney injury, but fewer intracardiac complications and lower surgical requirements, although mortality did not differ when compared with other pathogens. Sepsis and surgery indicated but not performed were risk factors for in-hospital death. Treatment was heterogeneous, utilizing several distinct regimens whose clinical use in IE is newly reported.

E. faecium infective endocarditis predominantly affects frail, healthcare-exposed patients and has a distinctive phenotype characterized by native-valve predominance, frequent renal complications, and fewer intracardiac lesions, yet persistently high mortality. These findings help define the clinical profile of this entity and support evaluation of alternative treatment strategies.