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Review
. 2023 Jun 21;36(2):e0005922.
doi: 10.1128/cmr.00059-22. Epub 2023 Apr 17.

Therapeutics for Vancomycin-Resistant Enterococcal Bloodstream Infections

Kelly A Cairns  1   2 , Andrew A Udy  3   4 , Trisha N Peel  1 , Iain J Abbott  1   5 , Michael J Dooley  2   6 , Anton Y Peleg  1   7   8
Affiliations
Review

Therapeutics for Vancomycin-Resistant Enterococcal Bloodstream Infections

Kelly A Cairns et al. Clin Microbiol Rev. .

Abstract

Vancomycin-resistant enterococci (VRE) are common causes of bloodstream infections (BSIs) with high morbidity and mortality rates. They are pathogens of global concern with a limited treatment pipeline. Significant challenges exist in the management of VRE BSI, including drug dosing, the emergence of resistance, and the optimal treatment for persistent bacteremia and infective endocarditis. Therapeutic drug monitoring (TDM) for antimicrobial therapy is evolving for VRE-active agents; however, there are significant gaps in the literature for predicting antimicrobial efficacy for VRE BSIs. To date, TDM has the greatest evidence for predicting drug toxicity for the three main VRE-active antimicrobial agents daptomycin, linezolid, and teicoplanin. This article presents an overview of the treatment options for VRE BSIs, the role of antimicrobial dose optimization through TDM in supporting clinical infection management, and challenges and perspectives for the future.

Keywords: VRE; bacteremia; daptomycin; linezolid; teicoplanin; therapeutic drug monitoring.

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Conflict of interest statement

The authors declare a conflict of interest. This research received no specific financial support. I.J.A. has undertaken advisory board consultancy for Merck Sharp & Dohme (Australia; June 2021); A.Y.P. has received an investigator-initiated research grant from Merck Sharp & Dohme unrelated to the current project.

Figures

FIG 1
FIG 1
Role of VRE in colonization and infection.
See this image and copyright information in PMC

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