Monotherapy vs combination therapy for Enterococcus faecalis bacteremia: a target trial emulation - PubMed
3 hours ago
- #Enterococcus faecalis
- #antimicrobial stewardship
- #bloodstream infection
- The study compares monotherapy versus combination therapy for treating Enterococcus faecalis bloodstream infection (EF-BSI) without endocarditis.
- A target trial emulation was conducted using a prospective, multicenter, international dataset from 24 centers (2019-2024).
- 373 patients were included, with 71% receiving monotherapy (mainly ampicillin) and the rest combination therapy (mostly ampicillin with ceftriaxone or gentamicin).
- Clinical failure (composite of death, relapse, or endocarditis at 90 days) occurred in 31% of patients, with no significant difference between monotherapy (28%) and combination therapy (36%).
- Sepsis or septic shock at presentation was the only independent factor associated with clinical failure.
- The study found no significant benefit of combination therapy over monotherapy for EF-BSI, suggesting potential for therapeutic simplification in line with antimicrobial stewardship principles.