P-825. Clinical Features and Antimicrobial Susceptibility Patterns of Vancomycin-Resistant Enterococcus faecalis: A Single-Center Retrospective Study

TL;DR

This study examines the treatment patterns and antibiotic susceptibility of vancomycin-resistant Enterococcus faecalis infections in hospitalized patients.

Contribution

The study provides local insights into antimicrobial stewardship challenges and treatment outcomes for vancomycin-resistant E. faecalis.

Findings

Daptomycin was the most commonly used antibiotic despite higher susceptibility to ampicillin and nitrofurantoin.

7% of patients died within 60 days, and 27% were readmitted within 30 days.

No significant differences in mortality or relapse were found between ampicillin-based and non-ampicillin-based treatments.

Abstract

Despite its frequent susceptibility to ampicillin (Amp), vancomycin-resistant Enterococcus faecalis (VRE) is often clinically managed with Datpomcyin (Dapto) or other novel antibiotics. Broad-spectrum antibacterial agents raised concerns about overtreatment and challenged antimicrobial stewardship programs. This clinical study aims to assess the local E. faecalis VRE isolates susceptibility patterns and evaluate antibiotic treatments.Table 1.Characteristics of the Patients, Infections, and Co-pathogensTable 2.Vancomycin Resistant Enterococcus faecalis Susceptibility Pattern

Characteristics of the Patients, Infections, and Co-pathogens

Vancomycin Resistant Enterococcus faecalis Susceptibility Pattern

We conducted a retrospective cohort study of adult patients who were admitted at Ochsner LSU Health - Academic Medical Center between June 2018 and March 2025. We excluded Pts with concomitant non-Enterococcus faecalis VRE infections and those aged ≤18 years. Vancomycin resistance was defined by a minimum inhibitory concentration of >32 mcg/mL according to the 35th edition of the Clinical and Laboratory Standards Institution breakpoints.Table 3.Features of Antimicrobial RegimensTable 4.Clinical Outcomes and Reported Adverse Events

Features of Antimicrobial Regimens

Clinical Outcomes and Reported Adverse Events

A total of 337 patients were screened, 114 pts met the inclusion criteria. Baseline characteristics are summarized in Table 1. The cohort was 54% female and 50% AA, with 54% having HTN, 36% DM, and 19% of Pts had a history of MDRO carriage. The most common source of infection was urinary tract (67%), followed by SSTIs and bone/joint infections (11% each). The most frequently identified co-pathogens were Enterobacterales (48%). Resistance profiles are listed in Table 2. Out of 114 isolates, 82% were susceptible to Amp, 84% to nitrofurantoin, 61% to Dapto, and 70% to linezolid. Antimicrobial regimens are detailed in Table 3, with Dapto being the most used agent (19%). Clinical outcomes are presented in Table 4. Within 60 days, 7% of patients died, 9% experienced reinfection to the same pathogen, and 27% of pts were readmitted within 30 days. Adverse drug reactions were infrequent, with AKI occurring in 10% of pts. There were no statistically significant differences in 30-day mortality or relapse infections between pts who received an Amp-based regimen vs pts who were treated with non-Amp-based antibiotics.

Despite higher susceptibility to ampicillin and nitrofurantoin, daptomycin was the most used agent for Enterococcus faecalis VRE infections. These findings highlight an unmet need for improved antimicrobial stewardship and further clinical studies to guide optimal therapy.

All Authors: No reported disclosures

Figures