Enterococcal bacteraemia |
Publication: 22/07/2014 |
Next review: 09/01/2026 |
Clinical Guideline |
CURRENT |
ID: 3907 |
Approved By: Trust Clinical Guidelines Group |
Copyright© Leeds Teaching Hospitals NHS Trust 2023 |
This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated. |
Department of Microbiology Bacteraemia guideline
Enterococcal bacteraemia
Quick reference guide to the management of Enterococcal bacteraemia
- Aim
- Background
- About Enterococcus
- Antimicrobial susceptibilities
- Clinical differential diagnosis
- Antimicrobial treatment
- Supplementary Investigations
This document provides guidelines for doctors on the management of patients with confirmed bacteraemias (blood cultures). This document is supplementary to, and should be used in conjunction with, the antimicrobial guidelines.
Species: Enterococcus |
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The aim of this guideline is to:
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The blood culture process: Timings of culture, identification, susceptibility tests and clinical liaison. |
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Enterococci are gram-positive organisms, oval in shape and can be seen as single cells, pairs, short or long chains. Most clinical infections are produced by two species (Enterococcus faecalis and Enterococcus faecium). Enterococci have developed mechanisms to survive in the gastrointestinal tract of humans. One of the main effects that antibiotics have in the human gut is to alter the colonization in favor of enterococci. Other factors including increased stomach pH (use of PPIs) may also play a role in the overgrowth of enterococci3 Vancomycin Resistant Enterococci (VRE) are among the causes of nosocomial infections. Most VRE isolates are E. faecium (>90%). Risk factors associated with increased VRE colonization include: immunosuppression, diabetes, renal failure, increased hospital stay, residence in long-term care facility, broad spectrum antibiotics or Vancomycin. After a patient becomes colonized with VRE, the risk of developing bloodstream infection appears to increase4 |
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The differential diagnosis of enterococcal bacteremia includes:
Of note: Patients with a community-acquired Enterococcal bacteraemia should be assessed for a possible diagnosis of endocarditis. |
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History of the following are important to determine appropriate antimicrobial therapy
The table below outlines some of the common infections associated with Enterococcal bacteraemia.
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Consider further investigations as appropriate to source of infection, please see relevant guidelines. Further Action: Source Isolation of patients with VRE infection/colonization |
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Provenance
Record: | 3907 |
Objective: | |
Clinical condition: | Bacteraemia |
Target patient group: | |
Target professional group(s): | Pharmacists Secondary Care Doctors |
Adapted from: |
Evidence base
- BNF
- EMC
- Stiefel U,et al. Suppresion of gastric acid production by Proton Pump Inhibitor facilitates colonization of the large intestine by Vancomycin-Resistant Enterococcus and Klebsiella pneumonia in Clindamycin-treated mice. Antimicrob. Agents Chemother. November 2006 vol. 50 no. 11 3905-3907
- Weinstock DM,et al. Colonization, bloodstream infection and mortality caused by Vancomyci-Resistant Enterococcus early after allogenic stem cell transplant. Biol Blood Marrow Transplant. 2007;13:615-21
Approved By
Trust Clinical Guidelines Group
Document history
LHP version 1.0
Related information
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