Systematic Review and Meta-Analysis of Linezolid versus Daptomycin for Treatment of Vancomycin-Resistant Enterococcal Blood Stream Infections.
Antimicrob Agents Chemother. 2013 Jul 29;
Authors: Whang DW, Miller LG, Partain NM, McKinnell JA
Abstract
Objective: Bloodstream infections due to vancomycin-resistant enterococci (VRE-BSI) result in substantial patient mortality and cost. Daptomycin and linezolid are commonly prescribed for VRE-BSI, but there are no clinical trials to determine optimal antibiotic selection. We conducted a systematic review for investigations that compared daptomycin and linezolid for VRE-BSI.Methods: We searched MEDLINE from 1966 through 2012 for comparisons of linezolid and daptomycin for VRE-BSI. We included searches of EMBASE, clinicaltrials.gov, and national meetings. Data were extracted using a standardized instrument. Pooled odds ratios (OR) and 95% confidence interval (95% CI) were calculated using a fixed effects model.Results: Our search yielded 4,243 publications, of which 482 contained data on VRE treatment. Most studies (452/482) did not present data on BSI or did not provide information on linezolid or daptomycin. Among the remaining 30 studies, 9 offered comparative data between the two agents. None were randomized clinical trials. There was no difference in microbiologic (n=5 studies, 517 patients; OR=1.0, 95%-CI=0.4-1.7, p=0.95) or clinical cure (n=3 studies, 357 patients; OR=1.2, 95%-CI=0.7-2.0, p=0.7) between the two antibiotics. There was a trend toward increased survival with linezolid compared to daptomycin (n=9 studies, 1,074 patients; OR=1.3, 95%-CI=1.1-1.8, I(2)=0), but this did not reach statistical significance (p=0.054).Conclusions: There are limited data to inform clinicians on optimal antibiotic selection for VRE-BSI. Available studies are limited by small sample size, lack of patient-level data, and inconsistent outcome definitions. Additional research, including randomized clinical trials, is needed before conclusions can be drawn about treatment options for VRE therapy.
PMID: 23896468 [PubMed - as supplied by publisher]