Successful Treatment of Persistent Bacteremia due to Vancomycin-Resistant, Ampicillin-Resistant Enterococcus faecium

Endale T. Mekonen, Gary A. Noskin, Lance R. Peterson, Donna M. Hacek, Lance R. Peterson

Research output: Contribution to journalArticle

44 Scopus citations

Abstract

Emergence of vancomycin-resistant enterococci has become an increasing problem in many medical centers. We report a liver transplant recipient with vancomycin-resistant Enterococcus faecium bacteremia who was successfully treated using very high dose continuous infusion ampicillin/sulbactam, plus gentamicin after he remained bacteremic on high dose ampicillin and gentamicin. At our institution, 83% of E. faecium isolates from 1994 were inhibited by ampicillin/sulbactam compared to 66% for ampicillin at an MIC ≤64 μg/ml. None of these strains produced β-lactamase, suggesting sulbactam may have an unexplained beneficial effect against some enterococci. Although an MIC of ≤8 μg/ml is required for ampicillin to be considered active against enterococci, much higher levels of ampicillin or ampicillin/sulbactam are safely achievable. The response of our patient and the reported in vivo data have implications for future treatment of this pathogen, and may necessitate a reevaluation of susceptibility interpretation guidelines by clinical laboratories, and therapeutic drug dosing by clinicians.

Original languageEnglish (US)
Pages (from-to)249-253
Number of pages5
JournalMicrobial Drug Resistance
Volume1
Issue number3
DOIs
StatePublished - Apr 1995

ASJC Scopus subject areas

  • Microbiology
  • Immunology
  • Pharmacology
  • Microbiology (medical)

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