Empiric Antibiotics: Vancomycin-Resistant Enterococcus

Basics

  • GI or GU infections in patients with prior abx
  • Bacteremia, endocarditis in those with extensive HC exposure
  • E. faecalis: Often remains sensitive to ampicillin, beta-lactams
  • E. faecium: Often multi-drug resistant

Cystitis Rx

  • Consider Nitrofurantoin or Fosfomycin

Invasive infections Rx

  • Amp-sens VRE faecalis: Amp, Amp/Sulb, Pip/Tazo, Imi/Meropenem active
  • Linezolid, High dose Daptomycin (8-12 mg/kg daily), Tigecycline à Consult ID for assistance