Impact of Different Antimicrobial Therapies on Clinical and Fiscal Outcomes of Patients with Bacteremia Due to Vancomycin-Resistant Enterococci

Abstract

f Vancomycin-resistant enterococci (VRE) are a growing health problem, and uncertainties exist regarding the optimal therapy for bloodstream infection due to VRE. We conducted systematic comparative evaluations of the impact of different antimicrobial therapies on the outcomes of patients with bloodstream infections due to VRE. A retrospective study from January 2008 to October 2010 was conducted at Detroit Medical Center. Unique patients with blood cultures due to VRE were included and reviewed. Three major therapeutic classes were analyzed: daptomycin, linezolid, and ␤-lactams. Three multivariate models were conducted for each outcome, matching for a propensity score predicting the likelihood of receipt of one of the therapeutic classes. A total of 225 cases of bacteremia due to VRE were included, including 86 (38.2%) cases of VR Enterococcus faecalis and 139 (61.8%) of VR Enterococcus faecium. Bacteremia due to VR E. faecalis was more frequent among subjects treated with ␤-lactams than among those treated with daptomycin or linezolid. The median dose of daptomycin was 6 mg/kg of body weight (range, 6 to 12 mg/kg). After controlling for propensity score and bacteremia due to VR E. faecalis, differences in mortality were nonsignificant among the treatment groups. Therapy with daptomycin was associated with higher median variable direct cost per day than that for linezolid. This large study revealed the three therapeutic classes (daptomycin, linezolid, and ␤-lactams) are similarly efficacious in the treatment of bacteremia due to susceptible strains of VRE.

Vancomycin-resistente Enterokokken: Welche Therapieoptionen gibt es?

“…Seine Wirksamkeit ist bei VRE-Bakteriämien mit anderen Antibiotika wie Betalaktamen und Daptomycin vergleichbar [14,42]. Linezolid ist zugelassen zur Therapie von ▶ ambulant erworbenen und nosokomialen Pneumonien und ▶ schweren Haut-und Weichgewebeinfektionen durch empfindliche grampositive Erreger.…”

Antimicrobial (Drug) Resistance

“…Enterococci are of special interest because they also pose the issue of antibiotic resistance, such as Vancomycin-resistant Enterocci (VRE). Linezoid is the most frequently used antibiotic in VRE treatment [7,8]. Tigecycline is an effective alternative to Linezoid [9].…”

Daptomycin for the treatment of bacteraemia due to vancomycin-resistant enterococci

“…Similarly, all-cause 30-day mortality was also comparable between groups (23% vs. 24%; P = 0.93) [44]. Finally, a recently published study retrospectively analysed the outcomes of 225 patients with VRE bacteraemia treated with DAP, linezolid or β-lactams [45]. Among these, 139 (62%) were infected with E. faecium and 86 (38%) with E. faecalis ; overall, 56 cases received DAP, 112 linezolid and 57 were treated with β-lactams.…”

“…In this study, patients in the DAP group were more likely to be immunosuppressed, to have haematological malignancies and indwelling devices, and to require invasive procedures. After a cost analysis, DAP was associated with a higher cost during the hospitalisation compared with linezolid and β-lactam therapy ( P = 0.01 and P = 0.03, respectively) [45]. …”