Antimicrobial Stewardship in Vancomycin-Resistant Enterococcus faecalis: Clinical Study Evaluating Antimicrobial Susceptibility Patterns and Antibacterial Regimens
Abstract
Background: Vancomycin-resistant enterococci (VRE) Enterococcus faecalis (E. faecalis) remains largely ampicillin-susceptible, yet broad-spectrum agents are frequently used empirically (i.e., daptomycin and linezolid). Despite its frequent susceptibility to ampicillin, VRE E. faecalis is often managed with broad-spectrum antimicrobials, raising concerns about overtreatment and antimicrobial stewardship. Resistance mechanisms vary, with vancomycin resistance mediated by vanA/vanB operons and beta-lactams by altered penicillin binding proteins. These distinct mechanisms help explain why VRE E. faecalis isolates may remain susceptible to ampicillin, supporting its potential use in clinical isolates. This study aims to describe the antibacterial susceptibility results of Enterococcus faecalis VRE and assess antibiotics use in clinical settings in a tertiary medical center. Methods: This was a single-center, retrospective, descriptive study of hospitalized and outpatient adults with Enterococcus faecalis VRE isolates identified between 1 June 2018 and 15 March 2025. We excluded individuals with concomitant non-Enterococcus faecalis VRE infections and those aged 32 mcg/mL per the 35th edition of the Clinical and Laboratory Standards Institution breakpoints. Results: A total of 337 patients were screened; 114 met inclusion criteria. The cohort was 54% female, 50% Black, and 48% White, with 54% having hypertension, 36% diabetes, and 19% a history of multidrug-resistant organism…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 337 participants or records.
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