Managing Enterococcus faecium bloodstream infection: a Delphi document on clinical recommendations and research agenda
- Author(s)
- Rinaldi, M; Bartoletti, M; Cojutti, P; Escolà-Vergé, L; Fernández-Hidalgo, N; Hornuss, D; Gatti, M; Gudiol, C; Gutiérrez-Gutiérrez, B; López-Cortés, LE; Kern, WV; Los-Arcos, I; Muñoz, P; Oliva, A; Papadimitriou-Olivgeris, M; Pai, M; Pea, F; Pericas, JM; Rieg, S; Russo, A; Soriano, A; Thursky, K; Udy, A; Venditti, M; Yahav, D; Mo, Y; Viale, P; Giannella, M; ESGBIES Study Group;
- Journal Title
- eClinicalMedicine
- Publication Type
- Research article
- Abstract
- BACKGROUND: Management of E faecium bloodstream infections (BSIs) remains debated, particularly the clinical impact of vancomycin resistance, the role of follow-up cultures, and optimal therapeutic regimens. This study aimed to reach expert consensus on these unresolved clinical domains and identify priorities for future research. METHODS: We first conducted a systematic review and meta-analysis in January 20, 204 focusing on four predefined areas: mortality in E faecium BSIs compared with other BSIs, mortality in vancomycin-resistant enterococci (VRE)-BSIs compared with vancomycin-susceptible enterococci-BSIs, management of catheter-related E faecium BSIs, and 4) optimal antibiotic therapy for VRE-BSIs. These results informed a three-round Delphi process involving a panel of experts. An iterative approach was adopted: 16 initial questions developed from the systematic review (6-point Likert scale) were refined across rounds based on expert feedback. Consensus was defined as at least 80% agreement or disagreement. FINDINGS: 13 statements were generated across three broader domains. Regarding clinical outcomes and diagnostics, experts agreed that mortality is heavily influenced by comorbidities; thus, therapeutic assessment should rely on clinical trends and inflammatory markers, with follow-up blood cultures used to confirm eradication. Catheter-related BSI should be managed with device removal and short-course (<7 days) antibiotics in selected uncomplicated cases. For therapeutic management, teicoplanin is preferred for vanB VRE-BSI. For vanA VRE-BSI, both linezolid and high-dose daptomycin (>9 mg/kg per day) are effective, reserving daptomycin-based combinations for challenging cases (deep-seated infections and/or high Minimum Inhibitory Concentrations). Finally, future trials evaluating the impact of antimicrobial therapy should use Desirability-of-Outcome-Ranking analysis; the in-vitro potential of oritavancin justifies targeted randomized trials to define its clinical efficacy in VRE-BSI. INTERPRETATION: This paper delineates current evidence and expert consensus on management of E faecium BSI while identifying crucial knowledge gaps to guide future clinical research. FUNDING: None.
- Publisher
- Springer Nature
- Keywords
- Bloodstream infection; Delphi; E faecium; Management
- Department(s)
- Infectious Diseases
- Publisher's Version
- https://doi.org/10.1016/j.eclinm.2026.103925
- Open Access at Publisher's Site
https://doi.org/10.1016/j.eclinm.2026.103925- Terms of Use/Rights Notice
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Creation Date: 2026-05-19 06:10:15
Last Modified: 2026-05-19 06:10:46