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JAC Advance Access originally published online on May 7, 2009
Journal of Antimicrobial Chemotherapy 2009 64(1):175-180; doi:10.1093/jac/dkp154
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© The Author 2009. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Original research

Vancomycin-resistant enterococcal bacteraemia: is daptomycin as effective as linezolid?

Vidya Mave1, Julia Garcia-Diaz2, Tareq Islam3 and Rodrigo Hasbun4,*

1 Department of Medicine, Section of Infectious Diseases, Tulane University School of Medicine, New Orleans, LA, USA 2 Division of Infectious Diseases, Oschner Clinic Foundation, New Orleans, LA, USA 3 Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA 4 Department of Medicine, Division of Infectious Diseases, University of Texas Health Sciences Center, Houston, TX, USA

Received 14 January 2009; returned 9 February 2009; revised 2 April 2009; accepted 4 April 2009

* Corresponding author. Tel: +1-713-500-7140; Fax: +1-713-500-5495; E-mail: rodrigo.hasbun{at}uth.tmc.edu

Background: The treatment of vancomycin-resistant enterococcal (VRE) bacteraemia remains challenging. Daptomycin is a new antibiotic with bactericidal activity against VRE, but available clinical data are limited.

Methods: A retrospective study was performed on 98 adult patients with VRE bacteraemia admitted to two hospitals between September 2003 and December 2007 to compare the efficacy of daptomycin with that of linezolid. Multivariable analyses were performed to compare the microbiological and clinical outcomes of both groups.

Results: Out of 98 patients with VRE bacteraemia, 68 were treated with linezolid and 30 with daptomycin. Univariate analyses showed no significant differences between the groups regarding baseline demographic and clinical characteristics, severity of illness and co-morbidity. Daptomycin was associated with a trend towards a higher mortality rate (26.7% versus 20.6%), longer median duration of bacteraemia (3 days versus 2 days) and higher relapse rate (6.7% versus 2.9%), but these differences did not reach statistical significance (P > 0.2). Microbiological cure rates were 90% for the daptomycin group and 88.2% for the linezolid group (P = 0.92).

Conclusions: Despite a trend towards worse outcomes, daptomycin was as effective as linezolid in treating VRE bacteraemia. A randomized clinical trial is needed to confirm these results.

Keywords: antibiotic resistance , sepsis , multivariable analyses , microbiological outcomes


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