title: Assessing outcomes of adult oncology patients treated with linezolid versus daptomycin for bacteremia due to vancomycin-resistant Enterococcus.
abstract: BACKGROUND
  The incidence and severity of vancomycin-resistant Enterococcus blood stream infections continue to rise and is a significant burden in the healthcare setting. Literature thus far is minimal regarding treatment outcomes in patients with malignancy and vancomycin-resistant Enterococcus bacteremia. Appropriate antibiotic selection is vital to treatment success due to high rates of resistance, limited antimicrobials and mortality in this patient population. We conducted this study to determine whether treatment outcomes differed between cancer patients treated with linezolid and those treated with daptomycin for vancomycin-resistant Enterococcus bacteremia.
  
  
  METHODS
  This single-center, retrospective study included adult patients hospitalized on the oncology service with documented vancomycin-resistant Enterococcus faecium or Enterococcus faecalis bacteremia who received at least 48 h of either linezolid or daptomycin as primary treatment.
  
  
  RESULTS
  A total of 65 patients were included in the analysis. Thirty-two patients received daptomycin as primary treatment, and 33 patients received linezolid as primary treatment. Twenty-six (76.5%) patients in the linezolid cohort versus 22 (71%) patients in the daptomycin cohort achieved microbiological cure (p = 0.6141). Median length of stay in days (30 vs. 42, p = 0.0714) and mortality (7/32 (20.6%) vs. 8/33 (25.8%), p = 0.6180) were also similar between the linezolid and daptomycin treated patients, respectively.
  
  
  CONCLUSIONS
  No differences in microbiological cure, length of stay or mortality were identified between the groups. This study suggests that linezolid and daptomycin are each reasonable options for treating vancomycin-resistant Enterococcus bacteremia in oncology patients. Further prospective, randomized controlled trials are needed to assess the optimal treatment for vancomycin-resistant Enterococcus bacteremia in this patient population.
authors.affiliation: Department of Pharmacy, North Shore University Hospital, Manhasset, USA khilnapatel@gmail.com.
authors.forename: Khilna
authors.initials: K
authors.lastname: Patel
authors.affiliation: Department of Pharmacy, North Shore University Hospital, Manhasset, USA.
authors.forename: Rubiya
authors.initials: R
authors.lastname: Kabir
authors.affiliation: Department of Pharmacy, North Shore University Hospital, Manhasset, USA.
authors.forename: Samrah
authors.initials: S
authors.lastname: Ahmad
authors.affiliation: Department of Medicine, North Shore University Hospital-LIJ School of Medicine, Manhasset, USA.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Allen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D015331:Cohort Studies; D017576:Daptomycin / Q000494:pharmacology / Q000627:therapeutic use*; D016983:Enterococcus / Q000187:drug effects* / Q000502:physiology; D005260:Female; D006801:Humans; D000069349:Linezolid / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014640:Vancomycin / Q000494:pharmacology / Q000627:therapeutic use; D020713:Vancomycin Resistance / Q000187:drug effects* / Q000502:physiology
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin; D000069349:Linezolid; D017576:Daptomycin
keywords: Vancomycin-resistant Enterococcus; bacteremia; daptomycin; linezolid; malignancy