title: Impact of different antimicrobial therapies on clinical and fiscal outcomes of patients with bacteremia due to vancomycin-resistant enterococci.
abstract: Vancomycin-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 VR Enterococcus faecalis and 139 (61.8%) of VR Enterococcus faecium. Bacteremia due to VR E. faecalis was 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 VR E. 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.
authors.affiliation: Division of Infectious Diseases, Wayne State University, Detroit Medical Center, Detroit, Michigan, USA Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan kayokohayakawa@gmail.com.
authors.forename: Kayoko
authors.initials: K
authors.lastname: Hayakawa
authors.affiliation: Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA.
authors.forename: Emily T
authors.initials: ET
authors.lastname: Martin
authors.affiliation: Division of Infectious Diseases, Wayne State University, Detroit Medical Center, Detroit, Michigan, USA.
authors.forename: Uma Mahesh
authors.initials: UM
authors.lastname: Gudur
authors.affiliation: Division of Infectious Diseases, Wayne State University, Detroit Medical Center, Detroit, Michigan, USA.
authors.forename: Dror
authors.initials: D
authors.lastname: Marchaim
authors.affiliation: Division of Infectious Diseases, Wayne State University, Detroit Medical Center, Detroit, Michigan, USA.
authors.forename: Dalia
authors.initials: D
authors.lastname: Dalle
authors.affiliation: Division of Infectious Diseases, Wayne State University, Detroit Medical Center, Detroit, Michigan, USA.
authors.forename: Khaled
authors.initials: K
authors.lastname: Alshabani
authors.affiliation: Division of Infectious Diseases, Wayne State University, Detroit Medical Center, Detroit, Michigan, USA.
authors.forename: Kalyan Srinivas
authors.initials: KS
authors.lastname: Muppavarapu
authors.affiliation: Division of Infectious Diseases, Wayne State University, Detroit Medical Center, Detroit, Michigan, USA.
authors.forename: Fnu
authors.initials: F
authors.lastname: Jaydev
authors.affiliation: Division of Infectious Diseases, Wayne State University, Detroit Medical Center, Detroit, Michigan, USA.
authors.forename: Pradeep
authors.initials: P
authors.lastname: Bathina
authors.affiliation: Division of Infectious Diseases, Wayne State University, Detroit Medical Center, Detroit, Michigan, USA.
authors.forename: Pranathi Rao
authors.initials: PR
authors.lastname: Sundaragiri
authors.affiliation: Division of Infectious Diseases, Wayne State University, Detroit Medical Center, Detroit, Michigan, USA.
authors.forename: Shashi Dhar
authors.initials: SD
authors.lastname: Rajuri
authors.affiliation: Division of Infectious Diseases, Wayne State University, Detroit Medical Center, Detroit, Michigan, USA.
authors.forename: Jaikumar
authors.initials: J
authors.lastname: Khatri
authors.affiliation: Division of Infectious Diseases, Wayne State University, Detroit Medical Center, Detroit, Michigan, USA Department of Pharmacy Services, Detroit Medical Center, Detroit, Michigan, USA.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Pogue
authors.affiliation: Detroit Medical Center University Laboratories, Detroit, Michigan, USA.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Lephart
authors.affiliation: Division of Infectious Diseases, Wayne State University, Detroit Medical Center, Detroit, Michigan, USA Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Rybak
authors.affiliation: Division of Infectious Diseases, Wayne State University, Detroit Medical Center, Detroit, Michigan, USA.
authors.forename: Keith S
authors.initials: KS
authors.lastname: Kaye
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000191:economics* / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000191:economics* / Q000382:microbiology; D015331:Cohort Studies; D017576:Daptomycin / Q000191:economics / Q000627:therapeutic use; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000191:economics* / Q000382:microbiology; D017721:Hospital Costs; D006801:Humans; D000069349:Linezolid / Q000191:economics / Q000627:therapeutic use; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012720:Severity of Illness Index; D020713:Vancomycin Resistance / Q000187:drug effects*; D065507:Vancomycin-Resistant Enterococci / Q000187:drug effects*; D047090:beta-Lactams / Q000191:economics / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D047090:beta-Lactams; D000069349:Linezolid; D017576:Daptomycin