What is the best course of action for a patient with enterococci resistant to gentamicin and acute kidney injury?

In the context of enterococci infections resistant to gentamicin and a patient with acute kidney injury, the most appropriate choice is to use ampicillin plus ceftriaxone. This combination is effective against enterococci that are not resistant to all beta-lactams.

Ampicillin is a standard treatment for enterococcal infections and demonstrates good activity against enterococci, especially when combined with ceftriaxone, which has synergistic effects and can also cover a broader spectrum of other potential pathogens. The use of this combination can enhance the efficacy of treatment while minimizing the nephrotoxic impact, especially important in a patient already experiencing acute kidney injury. This is crucial because managing renal function and using less nephrotoxic options is vital in such clinical scenarios.

Other choices may not provide the desired efficacy or safety in this specific situation. For instance, daptomycin is an alternative used for resistant enterococcal infections, but it is not the first-line choice due to considerations regarding its mechanism, which does not cover certain types of enterococci, and its limitations concerning renal impairment. Similarly, while vancomycin plus rifampin could be effective for resistant staphylococci, it is not as indicated