Non-faecium VRE

has a diabetic foot osteomyelitis . Blood cultures grow vancomycin-resistant Enterococcus gallinarum which is susceptible to ampicillin. The patient is on empiric vancomycin and piperacillin-tazobactam .

Should vancomycin be changed to daptomycin for this VRE?

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Explanation: Enterococcus gallinarum is intrinsically resistant to vancomycin. While daptomycin and linezolid are considered “go-to” antibiotics for VRE, vancomycin resistant E. faecalis, E. gallinarum, and E. casseliflavus often remain susceptible to penicillins. Daptomycin and linezolid should be preserved for when penicillins are not available.

Non-faecium VRE

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