Author:
Hayakawa Kayoko,Martin Emily T.,Gudur Uma Mahesh,Marchaim Dror,Dalle Dalia,Alshabani Khaled,Muppavarapu Kalyan Srinivas,Jaydev Fnu,Bathina Pradeep,Sundaragiri Pranathi Rao,Rajuri Shashi Dhar,Khatri Jaikumar,Pogue Jason M.,Lephart Paul R.,Rybak Michael J.,Kaye Keith S.
Abstract
ABSTRACTVancomycin-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 β-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 VREnterococcus faecalisand 139 (61.8%) of VREnterococcus faecium. Bacteremia due to VRE. faecaliswas more frequent among subjects treated with β-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 VRE. 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 β-lactams) are similarly efficacious in the treatment of bacteremia due to susceptible strains of VRE.
Publisher
American Society for Microbiology
Subject
Infectious Diseases,Pharmacology (medical),Pharmacology
Cited by
25 articles.
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