Vancomycin-resistant Enterococcus bacteremia

An evaluation of treatment with linezolid or daptomycin

Jennifer D. Twilla, Chris K. Finch, Justin B. Usery, Michael Gelfand, Joanna Laizure, Joyce Broyles

Research output: Contribution to journalArticle

42 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)243-248
Number of pages6
JournalJournal of Hospital Medicine
Volume7
Issue number3
DOIs
StatePublished - Mar 1 2012

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Linezolid
Daptomycin
Bacteremia
Therapeutics
Length of Stay
Vancomycin-Resistant Enterococci
Recurrence

All Science Journal Classification (ASJC) codes

  • Leadership and Management
  • Fundamentals and skills
  • Health Policy
  • Care Planning
  • Assessment and Diagnosis

Cite this

Vancomycin-resistant Enterococcus bacteremia : An evaluation of treatment with linezolid or daptomycin. / Twilla, Jennifer D.; Finch, Chris K.; Usery, Justin B.; Gelfand, Michael; Laizure, Joanna; Broyles, Joyce.

In: Journal of Hospital Medicine, Vol. 7, No. 3, 01.03.2012, p. 243-248.

Research output: Contribution to journalArticle

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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.",
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