title: Vancomycin-resistant enterococcal bacteremia pharmacotherapy.
abstract: OBJECTIVE
  To review the literature on the pharmacotherapy of bloodstream infections (BSI) caused by vancomycin-resistant enterococci (VRE).
  
  
  METHODS
  A MEDLINE literature search was performed for the period 1946 to May 2014 using the search terms Enterococcus, enterococci, vancomycin-resistant, VRE, bacteremia, and bloodstream infection. References were also identified from selected review articles.
  
  
  METHODS
  English-language case series, cohort studies, and meta-analyses assessing the options in the pharmacotherapy of VRE BSIs in adult patients were evaluated.
  
  
  RESULTS
  Studies were identified that utilized linezolid, quinupristin/dalfopristin (Q/D), and daptomycin. In all, 8 comparative retrospective cohort studies, 2 meta-analyses of daptomycin and linezolid, and 3 retrospective comparisons of linezolid and Q/D were included for review. Mortality associated with VRE BSIs was high across studies, and the ability to determine differences in outcomes between agents was confounded by the complex nature of the patients included. Two meta-analyses comparing daptomycin with linezolid for VRE BSIs found modest advantages for linezolid, but these conclusions may be hampered by heterogeneity within the included studies.
  
  
  CONCLUSIONS
  VRE BSIs remain a difficult-to-treat clinical situation. Differences in toxicity between the agents used to treat it are clear, but therapeutic differences are more difficult to discern. Meta-analyses suggest that a moderate advantage for linezolid over daptomycin may exist, but problems with the nature of studies that they included make definitive conclusions difficult.
authors.affiliation: Hackensack University Medical Center, Hackensack, NJ, USA rpatel8984@gmail.com.
authors.forename: Ruchi
authors.initials: R
authors.lastname: Patel
authors.affiliation: Temple University School of Pharmacy, Philadelphia, PA, USA.
authors.forename: Jason C
authors.initials: JC
authors.lastname: Gallagher
mesh_terms: D000081:Acetamides / Q000494:pharmacology / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology; D017576:Daptomycin / Q000494:pharmacology / Q000627:therapeutic use; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D000069349:Linezolid; D023303:Oxazolidinones / Q000494:pharmacology / Q000627:therapeutic use; D014640:Vancomycin / Q000494:pharmacology / Q000627:therapeutic use*; D065507:Vancomycin-Resistant Enterococci / Q000187:drug effects; D014769:Virginiamycin / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D000081:Acetamides; D000900:Anti-Bacterial Agents; D023303:Oxazolidinones; D014769:Virginiamycin; C062940:quinupristin-dalfopristin; D014640:Vancomycin; D000069349:Linezolid; D017576:Daptomycin
keywords: VRE; bacteremia; daptomycin; linezolid; quinupristin/dalfopristin; telavancin; tigecycline; vancomycin-resistant enterococci