833. Efficacy and Safety of High-Dose Daptomycin versus Linezolid for the Treatment of Vancomycin-Resistant Enterococcus (VRE) Bacteremias: A Retrospective Study
Session: Poster Abstract Session: Bacteremia and Endocarditis
Friday, October 9, 2015
Room: Poster Hall
Posters
  • ID Week Poster 2015.pdf (3.4 MB)
  • Background: Several studies have compared linezolid to standard-dose daptomycin (6 mg/kg) for the treatment of vancomycin-resistant enterococcus (VRE) bacteremias but neither regimen has demonstrated superior clinical outcomes.  To our knowledge, there are no published studies comparing high-dose daptomycin (greater than 6 mg/kg) to linezolid for the treatment of VRE bacteremias.  The objective of this study is to compare the efficacy and safety of high-dose daptomycin to linezolid for the treatment of VRE bacteremias.

    Methods: Pertinent information were reviewed and obtained from electronic medical charts of eligible patients who were admitted to NYM from January 2011 to March 2015.  Patients 18 years of age or older with at least one documented VRE blood culture and who received either linezolid or high-dose daptomycin were included in this study.  Patients who were on concomitant anti-VRE antibiotics or received daptomycin for daptomycin-nonsusceptible or linezolid for linezolid-resistant VRE bacteremias were excluded.  Primary efficacy endpoints included microbiological clearance and clinical response rates.  Safety endpoints pertaining to adverse drug events were also collected.

    Results: Two hundred and four occurrences of enterococcal bacteremias were screened of which 41 patients met the selection criteria; 16 patients received high-dose daptomycin while 25 patients received linezolid.  The mean dose of daptomycin was 7.36 mg/kg.  Clinical response was documented in 8 of 16 patients (50%) treated with high-dose daptomycin as compared to 13 of 25 patients (52%) treated with linezolid (p = 1).  Among microbiologically evaluable patients, microbiological clearance was documented in 12 of 12 (100%) and 15 of 16 (93.8%) for the high-dose daptomycin and linezolid treatment cohorts, respectively (p = 1).  Discontinuation due to an adverse drug event occurred in 0 of 16 patients (0%) treated with high-dose daptomycin and 3 of 25 patients (12%) treated with linezolid (p = 0.27).

    Conclusion: Treatment with high-dose daptomycin or linezolid for VRE bacteremias was associated with similar clinical and microbiological outcomes.  Both regimens were generally well tolerated.

    James Truong, Pharm.D., Gary Wu, Pharm.D., Teena Abraham, M.S., Pharm.D. and Nasser Saad, Pharm.D., Pharmacy, New York Methodist Hospital, Brooklyn, NY

    Disclosures:

    J. Truong, None

    G. Wu, None

    T. Abraham, None

    N. Saad, None

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