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Comparison of the Effectiveness and Safety of Linezolid and Daptomycin in Vancomycin-Resistant Enterococcal Bloodstream Infection: A National Cohort Study of Veterans Affairs Patients.
Clin Infect Dis. 2015 Jun 10;
Authors: Britt NS, Potter EM, Patel N, Steed ME
Abstract
BACKGROUND: Vancomycin-resistant Enterococcus bloodstream infections (VRE-BSI) are becoming increasingly common. Linezolid and daptomycin are the primary treatment options for VRE-BSI, but optimal treatment is unclear.
METHODS: This was a national retrospective cohort study comparing linezolid and daptomycin for the treatment of VRE-BSI among Veterans Affairs (VA) medical center patients admitted January 2004 - 2013. The primary outcome was treatment failure, defined as a composite of: i) 30-day all-cause mortality; ii) microbiological failure; and iii) 60-day VRE-BSI recurrence. Poisson regression was conducted to determine if antimicrobial treatment was independently associated with clinical outcomes.
RESULTS: There were 644 patients included (linezolid [n=319]; daptomycin [n=325]). Overall, treatment failure was 60.9% (n=392/644) and 30-day all-cause mortality was 38.2% (n=246/644). Linezolid was associated with a significantly higher risk of treatment failure in comparison to daptomycin (risk ratio [RR], 1.37; 95% confidence interval [CI], 1.13-1.67; P=0.001). After adjusting for confounding factors in Poisson regression, the relationship between linezolid use and treatment failure persisted (adjusted RR, 1.15; 95% CI, 1.02-1.30; P=0.026). Linezolid was also associated with higher 30-day mortality (42.0% vs. 33.5%; RR, 1.17; 95% CI, 1.04-1.32; P=0.014) and microbiological failure rates (RR, 1.10; 95% CI, 1.02-1.18; P=0.011). No difference in 60-day VRE-BSI recurrence was observed between treatment groups.
CONCLUSIONS: Treatment with linezolid for VRE-BSI resulted in significantly higher treatment failure in comparison to daptomycin. Linezolid treatment was also associated with greater 30-day all-cause mortality and microbiological failure in this cohort.
PMID: 26063715 [PubMed - as supplied by publisher]