Treatment of Enterococcus faecalis Infective Endocarditis: A Continuing Challenge

Today, is one of the main causes of infective endocarditis in the world, generally affecting an elderly and fragile population, with a high mortality rate. Enterococci are partially resistant to many commonly used antimicrobial agents such as penicillin and ampicillin, as well as high-level resistan...

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Bibliographic Details
Published in:Antibiotics (Basel) 2023-04, Vol.12 (4), p.704
Main Authors: Herrera-Hidalgo, Laura, Fernández-Rubio, Beatriz, Luque-Márquez, Rafael, López-Cortés, Luis E, Gil-Navarro, Maria V, de Alarcón, Arístides
Format: Article
Language:English
Subjects:
Amides
Aminoglycosides
Ampicillin
Antibiotics
Antimicrobial agents
antimicrobial treatment
Carbapenems
Cephalosporins
Daptomycin
Drug resistance
Endocarditis
Enterococcus faecalis
Enzymes
Fosfomycin
High resistance
Infections
Multidrug resistance
Mutation
Oritavancin
Penicillin
resistances
Review
Tigecycline
β-Lactam antibiotics
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Summary:Today, is one of the main causes of infective endocarditis in the world, generally affecting an elderly and fragile population, with a high mortality rate. Enterococci are partially resistant to many commonly used antimicrobial agents such as penicillin and ampicillin, as well as high-level resistance to most cephalosporins and sometimes carbapenems, because of low-affinity penicillin-binding proteins, that lead to an unacceptable number of therapeutic failures with monotherapy. For many years, the synergistic combination of penicillins and aminoglycosides has been the cornerstone of treatment, but the emergence of strains with high resistance to aminoglycosides led to the search for new alternatives, like dual beta-lactam therapy. The development of multi-drug resistant strains of is a matter of considerable concern due to its probable spread to and have necessitated the search of new guidelines with the combination of daptomycin, fosfomycin or tigecycline. Some of them have scarce clinical experience and others are still under investigation and will be analyzed in this review. In addition, the need for prolonged treatment (6-8 weeks) to avoid relapses has forced to the consideration of other viable options as outpatient parenteral strategies, long-acting administrations with the new lipoglycopeptides (dalbavancin or oritavancin), and sequential oral treatments, which will also be discussed.
ISSN:2079-6382
2079-6382
DOI:10.3390/antibiotics12040704