Vancomycin-resistant Enterococcus (VRE) is an increasingly common nosocomial pathogen causing significant morbidity and mortality in patients with neutropenic cancer. We evaluated outcomes in an observed cohort of subjects with VRE bacteremia and compare the effectiveness of 2 antibiotics commonly used to treat VRE infections: daptomycin and linezolid.
Patients with neutropenic cancer with VRE blood stream infections treated with daptomycin or linezolid were identified through electronic medical record, and a retrospective chart review was conducted.
Eighty-one patients were included. There were 49 men (60%) and 32 women; the mean age was 59.3 years. Mean white blood cell count at the time of blood stream infection was 0.3, and the median duration of bacteremia was 2 days (range, 1–25 days). Leukemia was the underlying diagnosis in 82.7%. Only 4 patients received anti-VRE therapy within 4 hours, 14 patients received VRE-specific therapy within 24 hours of first positive culture. The overall treatment failure rate was 35.8%; daptomycin, 41.4%; and linezolid, 21.7% (P = 0.13). Primary causes of treatment failure were persistent bacteremia and death. The 30-day mortality rate was 38.3%. Of these 31 deaths, 22.6% were directly attributable to VRE, with VRE being contributory in an additional 22.6%. Overall mortality in patients treated with daptomycin (39.7%) or linezolid (34.8%) did not differ (P = 0.80). Resistance to both agents was observed.
We found a 38.3% 30-day mortality rate, emphasizing the need for prevention and perhaps early inclusion of VRE-specific therapy for those with known colonization. Outcomes of culture-directed therapy with linezolid or daptomycin did not differ by antibiotic choice.