VRE Cystitis

A 40 year old presents with persistent dysuria despite taking cephalexin as prescribed

Her previous urine culture grew Enterococcus faecium with the following susceptibility.

Ampicillin R
Vancomycin R
Daptomycin SDD

What is the best therapy?

A. Amoxicillin
B. Clindamycin
C. TMP-SMX
D. Daptomycin

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Best Answer

Amoxicillin

Explanation: Ampicillin is a surrogate for amoxicillin, and in general, we avoid antibiotics if a culture states “resistant”

BUT amoxicillin achieves high urinary concentrations (~115 - 1850 mcg/mL) which can exceed the CLSI resistance breakpoint of >= 16 mcg/mL. These susceptibility breakpoints are set based on blood concentrations, not urine.

VRE Cystitis

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