Enterococci are the third leading cause of IE and account for 10% of cases in non-IV drug users. E. faecalis causes 97% of enterococcal IE (EIE) cases, [1]. EIE tends to be more prevalent in prosthetic valves and is the leading causative agent of transaortic valve implant (TAVI) associated IE [2]. In a similar way, enterococcal IE is more common in patients with multiple comorbidities, in the elderly, and in patients with previous hospitalizations [3].

The clinical practice for EIE treatment is a combination of ampicillin/penicillin and gentamicin, or a double β-lactam regimen consisting of ampicillin and ceftriaxone [4] The latter is often preferred because of its lower risk of nephrotoxicity and the lack of need for measuring aminoglycoside serum concentrations. There is still, however, another practical complication with the latter regime. Once the patient is stable (absence of serious complication e.g., heart failure, major embolism, need for cardiac surgery or postoperative complications) and negative blood cultures are obtained, there is no need to continue treatment in the hospital setting. The common practice is to enable the patient to complete the remaining treatment at home.

Little evidence was found to support optimal continuation treatment [13]. Once discharged, ampicillin is a challenging antimicrobial to administer in an outpatient setting, since it is not stable in room temperature and requires six daily doses and hence repeated opening of the hub and connecting the antibiotic to a central line, which increases the risk for complications, including line infection.

One solution we have found to this problem, is to discharge patients diagnosed with EIE, once stable, to complete antibiotic treatment with a combination of twice daily ceftriaxone and continuous infusion of benzylpenicillin. This practice is not well established and there is scarce evidence to support it.

The purpose of this study was to assess two clinically significant issues related to EIE. First, to examine the trends in the incidence of EIE in the last decade. The second aim was to describe our experience with outpatient ceftriaxone and benzylpenicillin regimen for EIE including 2, 5, and 12 months follow up, as compared with EIE cases treated with standard IV antibiotic regimes.