Comparison of Linezolid and Daptomycin in the Treatment of Vancomycin-Resistant Enterococcal Bacteremia

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Objective:To describe the microbiological cure rate and clinical outcomes of linezolid and daptomycin pharmacotherapy in the treatment of vancomycin-resistant enterococcal (VRE) bacteremia.Methods:We performed a retrospective cohort study of patients who received either linezolid or daptomycin for the treatment of VRE bacteremia from January 2004 to March 2008. The patients were included if they received linezolid or daptomycin and had a positive blood culture for VRE. The primary end point was microbiological cure, defined as negative blood cultures for VRE at the end of therapy. Clinical outcomes at the end of treatment and adverse events were also evaluated.Results:Eighty-four patients were included: 47 received linezolid (600 mg every 12 hours) and 37 received daptomycin (median dose, 6.0 mg/kg; range, 3.7-8.8 mg/kg). Baseline thrombocytopenia was more common in the daptomycin group (56.8% vs. 19.1%; P < 0.001). Linezolid and daptomycin demonstrated similar rates of microbiological cure (89.4% vs. 86.5%; P = 0.67) and clinical success (50.0% vs. 64.7%; P = 0.19). Results were similar after adjustment for age, severity of illness, intensive care unit admission, and removal of indwelling cathethers. No patients relapsed in either arm. All-cause mortality was 38.3% (18 patients) and 32.4% (12 patients) in the linezolid and daptomycin group, respectively (P = 0.65).Conclusion:Linezolid and daptomycin therapy both seemed to be efficacious in the treatment of VRE bacteremia.

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