title: Treatment considerations in vancomycin-resistant enterococcal bacteremia: daptomycin or linezolid? A review.
abstract: BACKGROUND
  Vancomycin resistant enterococcal bloodstream infections are an important cause of morbidity and mortality in hospitalized patients.
  
  
  OBJECTIVE
  A search of the literature was undertaken to determine the optimal antimicrobial therapy for the management of vancomycin resistant enterococcal bloodstream infections.
  
  
  METHODS
  MEDLINE, EMBASE, and the Cochrane Library (unrestricted to time or language) were searched for studies of vancomycin resistant enterococcal bloodstream infections in adults reporting outcomes of direct comparisons of linezolid versus daptomycin on November 26, 2012. Studies of basic science, reviews, commentaries, pharmacologic, epidemiologic, or pediatric studies, and those studies examining conditions other than enterococcal bacteremia, a single antimicrobial agent or other antimicrobials were excluded.
  
  
  RESULTS
  226 studies were screened for eligibility and yielded eight studies evaluating a total of 807 patients. Inter-rater agreement was 100 %. Qualitative evaluation of the studies was performed using the Newcastle-Ottawa scale. No randomized controlled trials were identified. All studies were retrospective cohorts and non-randomized. 458 (57 %) patients treated with linezolid and 349 (43 %) with daptomycin were analyzed. Variable comorbidities and severity of illness were described in the included studies and reported here for comparison.
  
  
  CONCLUSIONS
  The optimal treatment of vancomycin resistant enterococcal bloodstream infections is yet to be determined. Well-designed prospective studies are needed to lend more convincing evidence regarding choice of antimicrobial therapy for this important multidrug resistant organism.
authors.affiliation: Department of Internal Medicine, Jackson Memorial Hospital, 1611 NW 12th Avenue, Central Building, Room 600D (R-60), Miami, FL, 33136, USA, bshukla@alum.emory.edu.
authors.forename: Bhavarth S
authors.initials: BS
authors.lastname: Shukla
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Gauthier
authors.forename: Ricardo
authors.initials: R
authors.lastname: Correa
authors.forename: Laura
authors.initials: L
authors.lastname: Smith
authors.forename: Lilian
authors.initials: L
authors.lastname: Abbo
mesh_terms: D000081:Acetamides / Q000627:therapeutic use*; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology; D017576:Daptomycin / Q000627:therapeutic use*; D016983:Enterococcus / Q000187:drug effects*; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000382:microbiology; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D000069349:Linezolid; D023303:Oxazolidinones / Q000627:therapeutic use*; D020713:Vancomycin Resistance
chemical_list: D000081:Acetamides; D000900:Anti-Bacterial Agents; D023303:Oxazolidinones; D000069349:Linezolid; D017576:Daptomycin
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