Systematic Review and Meta-Analysis of Linezolid and Daptomycin for Treatment of Vancomycin-Resistant Enterococcal Bloodstream Infections

Abstract

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. 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 intervals (95% CI) were calculated using a fixed-effects model. 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 to 1.7; P ‫؍‬ 0.95) and clinical (n ‫؍‬ 3 studies, 357 patients; OR, 1.2; 95% CI, 0.7 to 2.0; P ‫؍‬ 0.7) cures between the two antibiotics. There was a trend toward increased survival with linezolid compared to daptomycin treatment (n ‫؍‬ 9 studies, 1,074 patients; OR, 1.3; 95% CI, 1.1 to 1.8; I 2 ‫؍‬ 0 [where I 2 is a measure of inconsistency]), but this did not reach statistical significance (P ‫؍‬ 0.054). 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.

Bacteremia with an Iliopsoas Abscess and Osteomyelitis of the Femoral Head Caused by <i>Enterococcus avium</i> in a Patient with End-stage Kidney Disease

“…Supporting this proposal is the fact that daptomycin is recommended in addition to vancomycin in cases of MRSA bacteremia according to the current guidelines proposed by the Infectious Diseases Society of America for the treatment of MRSA infection, despite the absence of absolute superiority of this drug over vancomycin in patients with bone and joint infections (34,35). Of note, the superiority of daptomycin over linezolid for treating vancomycinresistant enterococcal infections is not clear, although the need for long-term administration suggests that daptomycin is more desirable than linezolid (36). However, daptomycin should be used appropriately, as a daptomycin-resistant enterococcal strain has previously been reported (37).…”

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

“…Recently published meta-analyses revealed increased survival with linezolid compared to that with daptomycin (18,19). One explanation for the differences in the findings in these studies compared to the current one is that these prior studies included In the financial data cohort, 33 (91.7%) subjects within the daptomycin group were matched to 33 (31.4%) within the linezolid group; 23 (63.9%) subjects in the daptomycin group were matched to 23 (41.8%) in the ␤-lactam group; and 46 (43.8%) subjects in the linezolid group were matched to 46 (83.6%) subjects in the ␤-lactam group.…”

Importance Of The Rısk Factors For Vancomycın Resıstant Enterococcus Infectıon/Colonızatıon Development In Tertıary Intensıve Care Unıts

“…Other risk factors for VRE colonization include underlying diseases such as chronic renal failure, diabetes mellitus, cardiovascular disease and dialysis 25 . Development of VRE colonization can lead to a lifethreatening complication especially in the immunosuppressed patients 26 .…”

“…In a study by Pan et al, long stay in the intensive care unit was found as a major risk factor for VRE colonization 22 . VRE colonization 9,25 . In our study, use of antibiotic was found to be significantly higher in the rectal colonization group compared to the non-colonized group.…”