Enterococcus faecium

Can be contaminants.

Draw repeat cultures to confirm before starting treatment.

If the isolate happens to be susceptible to ampicillin or vancomycin, these agents should be used preferentially.

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.

If synergy is present, gentamicin MAY be added to ampicillin or vancomycin for the treatment of Enterococcus faecium 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.