HelixTalk Episode #126 - Alex, I’ll Take Enterococcal Resistance Patterns and Treatments for $1000

Date posted: February 16, 2021, 6:00 am

In this episode, we chat with Morgan Anderson, PharmD, BCIDP and alumna of RFUMS, about Enterococcal infections including patterns of antimicrobial resistance and recommended treatment options.

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Key Concepts

1. Enterococcus is a gram positive pathogen that is well known for intrinsic resistance to multiple antibiotic classes.  It causes infections both in the community and hospital setting.
2. Compared to E. faecalis, E. faecium is becoming more prevalent (especially in the hospital setting) and is much more likely to be resistant to ampicillin and vancomycin (VRE).
3. Enterococcal resistance to ampicillin is due to overproduction of penicillin binding proteins with low B-lactam affinity.  Resistance to vancomycin is due to changing the cross-link amino acid sequence from D-ala-D-ala to D-ala-D-lac.
4. For serious vancomycin-resistant Enterococcal infections, the three main therapies include daptomycin, linezolid, and tigecycline.

References

• García-Solache M, Rice LB. The Enterococcus: a Model of Adaptability to Its Environment. Clin Microbiol Rev. 2019;32(2):e00058-18. Published 2019 Jan 30. doi:10.1128/CMR.00058-18
• Yim J, Smith JR, Rybak MJ. Role of Combination Antimicrobial Therapy for Vancomycin-Resistant Enterococcus faecium Infections: Review of the Current Evidence. Pharmacotherapy. 2017;37(5):579-592. doi:10.1002/phar.1922