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Treatment of Vancomycin-Resistant Enterococcal Bacteremia in an Observational Cohort of Neutropenic Oncology Patients: Daptomycin Versus Linezolid

Barbour, Sarah MD*; Marion, Chad MD, DO; Kennedy, LeAnne PharmD; Russell, Gregory B. MS§; High, Kevin MD, MS

Infectious Diseases in Clinical Practice: July 2013 - Volume 21 - Issue 4 - p 240–246
doi: 10.1097/IPC.0b013e31827ce847
Original Articles

Background 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.

Methods 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.

Results 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.

Conclusions 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.

From the *Section on Infectious Diseases, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC; †Section of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; ‡Section on Hematology and Oncology, Department of Pharmacy and Department of Internal Medicine, Wake Forest Baptist Health; §Department of Biostatistical Sciences, Wake Forest School of Medicine; and ∥Section on Infectious Diseases, Department of Internal Medicine, Wake Forest University Baptist Medical Center, Winston-Salem, NC.

Correspondence to: Sarah Barbour, MD, Section on Infectious Diseases, Department of Internal Medicine, Wake Forest Baptist Medical Center, 1 Medical Center Blvd, Winston-Salem, NC 27157. E-mail:

The authors have no funding or conflicts of interest to disclose.

Verification of participation: All authors had access to the data and a role in writing the manuscript.

Presented in part as an abstract at Infectious Disease Society of America, 2008 Annual Meeting, Washington, DC, October 25–30, 2008.

© 2013 by Lippincott Williams & Wilkins.