Enterococcal Endocarditis Revisited

ABSTRACT

The Enterococcus species is the third main cause of infective endocarditis (IE) worldwide, and it is gaining relevance, especially among healthcare-associated cases. Patients with enterococcal IE are older and have more comorbidities than other types of IE. Classical treatment options are limited due to the emergence of high-level aminoglycosides resistance (HLAR), vancomycin resistance and multidrug resistance in some cases. Besides, few new antimicrobial alternatives have shown real efficacy, despite some of them being recommended by major guidelines (including linezolid and daptomycin). Ampicillin plus ceftriaxone 2 g iv./12 h is a good option for Enterococcus faecalis IE caused by HLAR strains, but randomized clinical trials are essential to demonstrate its efficacy for non-HLAR EFIE and to compare it with ampicillin plus short-course gentamicin. The main mechanisms of resistance and treatment options are also reviewed for other enterococcal species.

KEYWORDS:

• antibiotic options
• bloodstream infections
• endocarditis
• Enterococcus
• Gram-positive bacteria
• medical treatment

Authors’ note

The investigators of the Hospital Clinic Endocarditis Study Group, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain, are: JM Miro, JM Pericás, A Tellez, A Moreno, C Cervera and JM Gatell (Infectious Diseases Service); C García-de-la-Mària, Y Armero (Experimental Endocarditis Laboratory); F Marco, M Almela and J Vila (Microbiology Service); CA Mestres, JC Paré, C Falces, R Cartañá, S Ninot, M Azqueta, M Sitges, B Vidal, E Quintana, JM Tolosana, D Pereda and JL Pomar (Cardiovascular Institute); G Fita, I Rovira (Anesthesiology Department) J Ramírez, T Ribalta (Pathology Department); M Brunet (Toxicology Service); D Soy (Pharmacy Service); D Fuster, U Granados (Nuclear Medicine) and J Llopis (Statistics).

Financial & competing interests disclosure

JM Miró has received consulting honoraria and/or research grants from Abbott, Boehringer-Ingelheim, Bristol-Myers Squibb, Cubist, Novartis, Glaxo Smith Kline, Gilead Sciences, Pfizer, Roche, Theravance and ViiV. F Marco has received consulting honoraria from Novartis and Janssen-Cilag. JM Pericás and Y Zboromyrska both held an ‘Emili Letang’ Hospital Clinic of Barcelona Post-residency Scholarship during 2013–14. JM Pericas held a Rio Hortega Research Grant (CM14/00135) from the ‘Instituto de Salud Carlos III’ and the ‘Ministerio de Economia y Competitividad’ Madrid (Spain) in 2015–2016. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Additional information

Funding

JM Miró has received consulting honoraria and/or research grants from Abbott, Boehringer-Ingelheim, Bristol-Myers Squibb, Cubist, Novartis, Glaxo Smith Kline, Gilead Sciences, Pfizer, Roche, Theravance and ViiV. F Marco has received consulting honoraria from Novartis and Janssen-Cilag. JM Pericás and Y Zboromyrska both held an ‘Emili Letang’ Hospital Clinic of Barcelona Post-residency Scholarship during 2013–14. JM Pericas held a Rio Hortega Research Grant (CM14/00135) from the ‘Instituto de Salud Carlos III’ and the ‘Ministerio de Economia y Competitividad’ Madrid (Spain) in 2015–2016. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. No writing assistance was utilized in the production of this manuscript.