Managing Enterococcus faecium bloodstream infection: a Delphi document on clinical recommendations and research agenda
Year: 2026
Type: article
Abstract: Background: 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: 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: BSI while identifying crucial knowledge gaps to guide future clinical research. Funding: None.
Source: EClinicalMedicine
Authors: Matteo Rinaldi, Matteo Rinaldi, Michele Bartoletti, Piergiorgio Cojutti, Laura Escolà-Vergé, Nuria Fernández-Hidalgo, Daniel Hornuss, Milo Gatti, Carlota Gudiol, Belén Gutiérrez-Gutiérrez, Luis Eduardo López-Cortés, Winfried Vincenz Kern, Ibai Los-Arcos, Patricia Muñoz, Alessandra Oliva, Matthaios Papadimitriou-Olivgeris, Manjunath Pai, Federico Pea, Juan Manuel Pericas, Siegbert Rieg, Alessandro Russo, Alex Soriano, Karin Thursky, Andrew Udy, Mario Venditti, Dafna Yahav, Yin Mo, Pierluigi Viale, Maddalena Giannella, Matteo Rinaldi, Matteo Rinaldi, Michele Bartoletti, Winfried Vincenz Kern, Nuria Fernández-Hidalgo, Matthaios Papadimitriou-Olivgeris, Laura Escolà-Vergé, Maddalena Giannella, Juan Manuel Pericas, Pierluigi Viale
Institutions: IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola, University of Bologna, Humanitas University, IRCCS Humanitas Research Hospital, Universitat Autònoma de Barcelona, Instituto de Salud Carlos III, Hospital de Sant Pau, Centro de Investigación Biomédica en Red, Institut de Recerca Sant Pau, Centro de Investigación Biomédica en Red Enfermedades Infecciosas, Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, University of Freiburg, University Medical Center Freiburg, Bellvitge University Hospital, Institut d'Investigació Biomédica de Bellvitge, Universitat de Barcelona, Hospital Universitario Virgen Macarena, Instituto de Biomedicina de Sevilla, Universidad de Sevilla, Universidad Complutense de Madrid, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Investigación Sanitaria Gregorio Marañón, Policlinico Umberto I, Sapienza University of Rome, Hôpital du Valais, University of Michigan, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Magna Graecia University, Hospital Clínic de Barcelona, Consorci Institut D'Investigacions Biomediques August Pi I Sunyer, Peter MacCallum Cancer Centre, The Alfred Hospital, Monash University, Tel Aviv University, Sheba Medical Center, National University of Singapore
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $5,780
OpenAlex ID: W7160426889