Vancomycin‐resistant Enterococcus bacteremia: An evaluation of treatment with linezolid or daptomycin

Abstract

BACKGROUND: Due to high rates of resistance and a limited number of efficacious antimicrobials for vancomycin‐resistant Enterococcus (VRE), appropriate antibiotic selection is vital to treatment success. The purpose of this study was to assess clinical and microbiologic outcomes associated with the use of linezolid or daptomycin in the treatment of VRE bacteremia. METHODS: A retrospective analysis of adult patients with VRE bacteremia between January 2004 and July 2009 was conducted at a tertiary care hospital in the United States. Clinical and microbiologic outcomes for both therapies were evaluated using multiple criteria. RESULTS: Of the 361 patients with VRE bacteremia identified, 201 were included in the study (linezolid group, n = 138; daptomycin group, n = 63). More patients in the daptomycin group had hematologic malignancies (33% vs 14%) or received liver transplants (13% vs 4%). There was no difference in clinical or microbiologic cure between the linezolid and daptomycin groups (74% vs 75% and 94% vs 94%, respectively). Recurrence was documented in 3% of linezolid patients vs 12% of daptomycin patients (P = 0.0321). Reinfection was noted in 1% of patients in the linezolid group vs 6% of patients in the daptomycin group (P not significant). The average length of stay (LOS) was 37 days for the linezolid group vs 40 days for the daptomycin group (P not significant). Overall mortality was 20%, occurring in 25/138 linezolid patients vs 15/63 daptomycin patients (P not significant). CONCLUSIONS: No differences in clinical or microbiologic cure rates, LOS, or mortality were identified between the groups. Various factors may have contributed to the significantly higher recurrence of VRE bacteremia in daptomycin patients. This study suggests that linezolid and daptomycin appear equally efficacious in the treatment of VRE bacteremia. Journal of Hospital Medicine 2011;. © 2011 Society of Hospital Medicine.

Impact of Different Antimicrobial Therapies on Clinical and Fiscal Outcomes of Patients with Bacteremia Due to Vancomycin-Resistant Enterococci

“…These differences were accounted for, in part, in multivariate analyses, where no differences in mortality among treatment groups were identified. Our results are in accordance with previous studies which compared daptomycin to linezolid for treatment of bacteremia due to VRE (15)(16)(17): these reports did not find significant differences in mortality among patients treated with daptomycin or linezolid.…”

Low Rate of Infection Control in Enterococcal Periprosthetic Joint Infections

“…Regarding the antibiotic therapy, intravenous ampicillin, gentamicin, or vancomycin is sufficient for non-VRE species [8]. However, medical management of infected cases with VRE is more challenging and needs to be treated by either linezolid or daptomycin [20]. Irrigation and débri-dement, one-stage exchange arthroplasty, two-stage exchange arthroplasty, and salvage surgeries (fusion and amputation) are available surgical options for management of PJI.…”

Systematic Review and Meta-Analysis of Linezolid versus Daptomycin for Treatment of Vancomycin-Resistant Enterococcal Bacteremia

“…Vancomycin is the first-line treatment of BSIs caused by ampicillin-resistant enterococci; however vancomycin-resistant enterococci (VRE) nowadays account for approximately one-third of the enterococcal health care-associated infections in the United States (2) and for more than 20% of such infections in some European countries (3). Mortality rates in patients with VRE BSIs range between 20 and 46% (4)(5)(6). Patients with BSI due to VRE are 2.5 times more likely to die than patients with BSI due to vancomycin-susceptible strains (7).…”

“…According to the relevant clinical practice guidelines of the Infectious Diseases Society of America, linezolid or daptomycin is recommended for the treatment of catheter-related BSIs caused by ampicillin-and vancomycin-resistant enterococci (15). Limited data exist on the comparative efficacy of daptomycin versus linezolid for enterococcal bacteremias (5,6). Herein we summarize the available evidence and provide estimates of the clinical effectiveness of linezolid versus daptomycin for the treatment of VRE bacteremia by using meta-analytic methodology.…”