Comparison of Daptomycin and Linezolid in the Treatment of Vancomycin-Resistant Enterococcus faecium in the Absence of Endocarditis

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Abstract

Background

Although linezolid and daptomycin are frequently used for the management of vancomycin-resistant Enterococcus (VRE) bloodstream infection, optimal treatment is undefined.

Methods

We conducted a retrospective cohort study from January 2010 to December 2013 of patients with VRE faecium (VREF) bloodstream infection in the absence of endocarditis treated with daptomycin or linezolid at a single 802-bed teaching hospital in Detroit, Mich. Ninety-day all-cause mortality, length of stay, bacteremia duration, antibiotic duration, and recurrence at 30 days were evaluated. Multivariable analysis was performed to determine the effect of treatment selection on mortality.

Results

One hundred eighteen patients were included. Seventy-four patients received daptomycin and 44 linezolid. There was no significant difference in baseline characteristics between the 2 groups with the exception of nursing home residence (P = 0.007), intensive care unit admission (P = 0.049), receipt of chemotherapy (P = 0.013), and neutropenia (P = 0.007). Ninety-day all-cause mortality was 46% and 27% (odds ratio = 2.27; 95% confidence interval, 1.1–5.07; P = 0.044) and mean bacteremia duration was 3.6 and 2.6 days (odds ratio = 2.52; 95% confidence interval, 1.17–5.42; P = 0.037) for daptomycin and linezolid, respectively. There was no significant difference in mean length of stay, mean antibiotic duration, and recurrence between the 2 groups. Moreover, there were no significant differences in mortality between the 2 groups after controlling for variables such as chemotherapy, neutropenia, and renal replacement therapy that were associated with increased mortality.

Conclusions

Our study showed that there was no significant difference in mortality between linezolid and daptomycin for therapy of VRE bacteremia in the absence of endocarditis after controlling for other variables that were associated with increased mortality.

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