Therapeutics for Vancomycin-Resistant Enterococcal Bloodstream Infections

Vancomycin-resistant enterococci (VRE) are common causes of bloodstream infections (BSIs) with high morbidity and mortality rates. They are pathogens of global concern with a limited treatment pipeline. Significant challenges exist in the management of VRE BSI, including drug dosing, the emergence o...

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Bibliographic Details
Published in:Clinical microbiology reviews 2023-06, Vol.36 (2), p.e0005922-e0005922
Main Authors: Cairns, Kelly A, Udy, Andrew A, Peel, Trisha N, Abbott, Iain J, Dooley, Michael J, Peleg, Anton Y
Format: Article
Language:English
Subjects:
Anti-Bacterial Agents - pharmacology
Anti-Bacterial Agents - therapeutic use
Anti-Infective Agents - therapeutic use
Bacteremia - drug therapy
Clinical Microbiology
Gram-Positive Bacterial Infections - drug therapy
Humans
Linezolid - therapeutic use
Review
Sepsis
Vancomycin - pharmacology
Vancomycin - therapeutic use
Vancomycin-Resistant Enterococci
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Summary:Vancomycin-resistant enterococci (VRE) are common causes of bloodstream infections (BSIs) with high morbidity and mortality rates. They are pathogens of global concern with a limited treatment pipeline. Significant challenges exist in the management of VRE BSI, including drug dosing, the emergence of resistance, and the optimal treatment for persistent bacteremia and infective endocarditis. Therapeutic drug monitoring (TDM) for antimicrobial therapy is evolving for VRE-active agents; however, there are significant gaps in the literature for predicting antimicrobial efficacy for VRE BSIs. To date, TDM has the greatest evidence for predicting drug toxicity for the three main VRE-active antimicrobial agents daptomycin, linezolid, and teicoplanin. This article presents an overview of the treatment options for VRE BSIs, the role of antimicrobial dose optimization through TDM in supporting clinical infection management, and challenges and perspectives for the future.
ISSN:0893-8512
1098-6618
DOI:10.1128/cmr.00059-22