Hot Issues in Enterococcus faecalis bacteremia/endocarditis #IDWeek2021 ; my TLDR summary:
- E. faecalis is a typical endocarditis bacterium.
- Consider colo in pts with E. faecalis endocarditis (esp if unknown/community-acquired source) to assess for colonic malignancy.
- E. faecalis is a typical endocarditis bacterium.
- Consider colo in pts with E. faecalis endocarditis (esp if unknown/community-acquired source) to assess for colonic malignancy.
(In a 2021 study by Pericas et al, 70% of patients w/ E. faecalis IE had abnormalities on colo; ~15% had neoplasm, no differences seen between known/unknown source!)
- Amp has low affinity binding to PBP4/5 but is able to thin out the PPG cell wall enough for gent to enter.
- Amp has low affinity binding to PBP4/5 but is able to thin out the PPG cell wall enough for gent to enter.
- When exposed to amp, E. faecalis expresses PBP2/3 (high affinity for ceftriaxone). Yay.
- No modern RCTs have evaluated amp monotherapy for E. faecalis IE (2 studies, last from 1984, form the basis of the dual-therapy rec).
- Give twice daily ceftriaxone (4g IV qday is 👎).
- No modern RCTs have evaluated amp monotherapy for E. faecalis IE (2 studies, last from 1984, form the basis of the dual-therapy rec).
- Give twice daily ceftriaxone (4g IV qday is 👎).
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