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VRE Endocarditis — SCE Infectious Diseases MCQ

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HardBone & Joint InfectionVRE EndocarditisSCE Infectious Diseases

A 55-year-old man develops fever and a new murmur 8 weeks after a TAVI (transcatheter aortic valve implantation). Blood cultures grow Enterococcus faecium resistant to Ampicillin and Vancomycin (VanA phenotype). TOE confirms a vegetation on the bioprosthetic TAVI valve. What antibiotic is most appropriate?

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Correct answer: A — Daptomycin 8–10 mg/kg IV daily

VanA-type VRE E. faecium endocarditis resistant to both Ampicillin and Vancomycin is extremely challenging. Daptomycin at high dose (8–10 mg/kg daily) is the most evidence-supported option for VRE endocarditis. Ampicillin and Vancomycin are ineffective. Linezolid is bacteriostatic and has inferior outcomes for endocarditis (though it may be used in combination). Teicoplanin is ineffective against VanA phenotype. Surgical valve replacement should be considered early given the limited antibiotic options and poor prognosis.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/infections