Comparison of the Effectiveness and Safety of Linezolid and Daptomycin in Vancomycin-Resistant Enterococcal Bloodstream Infection: A National Cohort Study of Veterans Affairs Patients

Abstract

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 microbiologic failure in this cohort.

Effect of Continuous and Sequential Therapy among Veterans Receiving Daptomycin or Linezolid for Vancomycin-Resistant Enterococcus faecium Bacteremia

“…These individuals were treated at 99 VA medical centers across 48 states, the District of Columbia, and Puerto Rico. Of these patients, 539/2,779 (19.4%) were included in a previous study of hospitalized VA patients with VRE-BSI (13). The median DAP dose was 6.15 mg/kg (total body weight; interquartile range [IQR], 5.57 to 7.07 mg/kg).…”

“…In this study, DAP treatment was associated with improved clinical and microbiologic outcomes relative to LZD (13). While this study addressed several limitations of previous evaluations, many clinically important questions remain unanswered (13,14). Specifically, patients who were treated sequentially with DAP and then LZD were excluded from previous analyses, and this may have produced biased results if a significant portion of patients switched therapy due to clinical failure (13,14).…”

“…The comparative effectiveness of DAP and LZD for VREF-BSI was recently evaluated in a large national cohort study of hospitalized patients in the Veterans Affairs (VA) health care system (13). In this study, DAP treatment was associated with improved clinical and microbiologic outcomes relative to LZD (13).…”

“…While this study addressed several limitations of previous evaluations, many clinically important questions remain unanswered (13,14). Specifically, patients who were treated sequentially with DAP and then LZD were excluded from previous analyses, and this may have produced biased results if a significant portion of patients switched therapy due to clinical failure (13,14). The impacts of infectious diseases (ID) consultation and source of infection on outcomes in VREF-BSI have also not been extensively evaluated (13,14).…”

“…Specifically, patients who were treated sequentially with DAP and then LZD were excluded from previous analyses, and this may have produced biased results if a significant portion of patients switched therapy due to clinical failure (13,14). The impacts of infectious diseases (ID) consultation and source of infection on outcomes in VREF-BSI have also not been extensively evaluated (13,14). The present study sought to expand on findings of previous studies of VREF-BSI and address these gaps in the literature.…”