499. Treatment of Enterococcal Bloodstream Infection (BSI) with Linezolid
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Enterococcal spp. are a leading cause of healthcare associated BSI. Antimicrobial resistance rates of enterococci have steadily increased over the past 15 years. This increase in the past few years has led to increased utilization of linezolid for the treatment of bloodstream infections. Previously, concern has been raised regarding the use of linezolid for bloodstream infection. We evaluated predictors of mortality among patients treated with linezolid for enterococcal BSI.
Methods: Retrospective cohort of pts treated with linezolid for enterococcal BSI from 2006-08 at a 903-bed tertiary care hospital in Detroit. Data collected: medical history, microbiology and all-cause mortality. Of 64 patients treated with linezolid, 50 had 6-month mortality data available.
Results: 50 patients were identified with complete follow-up data. Crude 6-month mortality rate was 46%. Univariate comparison of risk factors for mortality are presented in Table 1. Independent predictors of all-cause mortality in logistic regression included (adj OR, 95%CI): age > 65 (5.5, 1.4-21.9) and failure to receive active therapy within 24 hours (4.6, 1.05 - 20.6).
Conclusions: Enterococcal BSI continues to have a high mortality rate. Among pts treated with linezolid, independent predictors of death included advanced age and delayed appropriate therapy.
Table 1. Univariate comparison of factors associated with mortality among 50 patients treated with linezolid for enterococcal BSI; data presented as n (% within variable)
VariableSurvivors (n=27)Non-survivors (n=23)P-value
Male gender (n=24)
Age > 65 years (n=19)
13 (54%)
6 (32)
11 (46%)
13 (68)
0.982
0.013
Source of BSI
Catheter (n=11)
Non-Catheter (n=39)
Endocarditis (n=6)
Non-Endocarditis (n=44)
Healthcare-associated (n=48)
Community-associated (n=2)
5 (46)
22 (56)
0 (0)
27 (61)
27 (56)
0 (0)
6 (54)
17 (44)
6 (100)
17 (39)
21 (44)
2 (100)
0.520
0.005
0.118
Susceptibility
Ampicillin-R (n=38)
Vancomycin-R (n=45)
18 (47)
24 (53)
20 (53)
21 (47)
0.094
0.777
Species
E. faecalis (n=13)
E. faecium (n=34)
Multiple (n=2)
Other (n=1)
9 (69)
18 (53)
0 (0)
0 (0)
4 (31)
16 (47)
2 (100)
1 (100)
0.191
Comorbid conditions
Dementia (n=7)
ESRD (n=14)
Prior vancomycin (n=36)
Immunosuppression (n=17)
1(14)
5 (36)
22 (61)
9 (53)
6 (86)
9 (64)
14 (39)
8 (47)
0.023
0.106
0.060
0.914
Polymicrobial bacteremia (n=16)7 (44)9 (56)0.164
Time to adequate therapy
Duration of bacteremia
Duration of therapy
Total length of stay
2 days (median)
3 days
14 days
21 days
3 days (median)
3 days
14 days
24 days
0.060
0.780
0.977
0.823

Category: C. Clinical and molecular studies of bacteria and antibacterials
Rachel Chambers, PharmD1, Susan L Davis, PharmD2, Jeff Hurren, PharmD1, Lindsay Lessl, PharmD Candidate3, Jason Watt, PharmD Candidate3, Marcus Zervos, MD4 and  J. Hurren, None..
L. K. Lessl, None..
J. E. Watt, None..
R. M. Chambers, None..
M. Zervos, None. 
S. L. Davis,
Pfizer Role(s): Grant Investigator, Scientific Advisor (Review Panel or Advisory Committee), Speaker's Bureau, Received: Research Support, Speaker Honorarium., (1)Henry Ford Hospital, Detroit, MI, (2)Wayne State University College of Pharmacy, Detroit, MI, (3)Wayne State University, Detroit, MI, (4)Infectious Disease, Henry Ford Hospital, Detroit, MI