Outcomes of therapy: vancomycin-resistant enterococcal bacteremia in hematology and bone marrow transplant patients.
OBJECTIVE
The purpose of this study was to evaluate the risk factors associated with the treatment failure and 30-day mortality in hematology and bone marrow transplant patients treated with daptomycin or linezolid for vancomycin-resistant enterococci (VRE) bacteremia. The safety and tolerability of therapy was also assessed.


METHODS
This single-center, retrospective study included adult patients admitted to the hematology or bone marrow transplant service with documented vancomycin-resistant Enterococcus faecium or Enterococcus faecalis bacteremia and received at least 48 h of either linezolid or daptomycin as primary treatment. Clinical and microbiologic outcomes were assessed at day 7, 14, and 30 of hospital stay.


RESULTS
A total of 72 patients were included in the analysis. Forty-three patients received daptomycin as primary treatment and 29 received linezolid as primary treatment. Overall success rate at day 7 was 81.9%, day 14 success rate was 79.2%, and day 30 success rate was 76.4% for all patients. Forty-one patients (57.0%) had high-grade bacteremia defined as greater than one positive blood culture for VRE. The mortality rate was significantly higher if high-grade bacteremia was present (34.1% vs. 7.0%; p = 0.009).


CONCLUSIONS
This study suggests that linezolid and daptomycin are both reasonable options for treating VRE bacteremia in hematology and bone marrow transplant patients; however, patients with high-grade VRE bacteremia may be at increased risk for treatment failure.
Department of Pharmacy, University of Michigan Health System, Ann Arbor, MI 48109, USA.
Shawna
S
Kraft
Emily
E
Mackler
Peter
P
Schlickman
Kathy
K
Welch
Daryl D
DD
DePestel
D000368:Aged; D016026:Bone Marrow Transplantation; D016983:Enterococcus / Q000187:drug effects*; D005260:Female; D006402:Hematologic Diseases; D006801:Humans; D008297:Male; D008824:Michigan; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D014640:Vancomycin / Q000627:therapeutic use*; D020713:Vancomycin Resistance
D014640:Vancomycin