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Role of Combination Antimicrobial Therapy for Vancomycin‐Resistant Enterococcus faecium Infections: Review of the Current Evidence
Author(s) -
Yim Juwon,
Smith Jordan R.,
Rybak Michael J.
Publication year - 2017
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1002/phar.1922
Subject(s) - linezolid , tigecycline , enterococcus faecium , dalbavancin , quinupristin , daptomycin , medicine , antimicrobial , enterococcus , vancomycin , dalfopristin , antibiotic resistance , vancomycin resistant enterococcus , microbiology and biotechnology , intensive care medicine , antibiotics , biology , staphylococcus aureus , bacteria , genetics
Enterococcus species are the second most common cause of nosocomial infections in the United States and are particularly concerning in critically ill patients with preexisting comorbid conditions. Rising resistance to antimicrobials that were historically used as front‐line agents for treatment of enterococcal infections, such as ampicillin, vancomycin, and aminoglycosides, further complicates the treatment of these infections. Of particular concern are Enterococcus faecium strains that are associated with the highest rate of vancomycin resistance. The introduction of antimicrobial agents with specific activity against vancomycin‐resistant Enterococcus ( VRE ) faecium including daptomycin, linezolid, quinupristin‐dalfopristin, and tigecycline did not completely resolve this clinical dilemma. In this review, the mechanisms of action and resistance to currently available anti‐ VRE antimicrobial agents including newer agents such as oritavancin and dalbavancin will be presented. In addition, novel combination therapies including β‐lactams and fosfomycin, and the promising results from in vitro , animal studies, and clinical experience in the treatment of VRE faecium will be discussed.