Enterococcus faecalis

Can be contaminants.

Draw repeat cultures to confirm before starting treatment.

Consider echocardiogram if there is persistent bacteremia >3 days on appropriate antibiotics, especially if the bacteremia was community-acquired.

Do not use gentamicin if the lab reports no synergy with gentamicin; doing so increases the risk of nephrotoxicity without clinical benefit.

Gentamicin or ceftriaxone MAY be added to ampicillin for the treatment of Enterococcus faecalis infective endocarditis.

When used for synergy, conventional dosing of aminoglycosides is preferred to extended-interval (once-daily) dosing.

Enterococcal endocarditis should not be treated with monotherapy. Infectious Disease consultation is strongly recommended for all cases of enterococcal endocarditis.