2019. Linezolid versus Daptomycin in the Treatment of Vancomycin-resistant Enterococcal bloodstream infection (VRE-BSI) at a Transplant center
Session: Poster Abstract Session: Antimicrobial Resistant Infections: Treatment
Saturday, October 29, 2016
Room: Poster Hall
Background:

Bloodstream infections due to vancomycin-resistant enterococci (VRE-BSI) result in substantial patient mortality and cost. Daptomycin (D) and Linezolid (L) are commonly prescribed for VRE-BSI, but there are no clinical trials to determine optimal antibiotic selection. Major advances have been made using real world comparative effectiveness analysis to define optimal antibiotic selection. However, VRE-BSI research frequently fails to consider the effect of clinical decision making and changing antibiotics during treatment and therefore loses an opportunity to help define optimal clinical practice.

Methods:

Cohort study of patients with VRE-BSI at Ronald Reagan Medical Center between January 2005 and December 2011. Patients with positive blood cultures, signs of infection, and treatment with antibiotics were included in the analysis. Medical records were reviewed and data abstracted using a standardized instrument for demographic information, presence of co-morbidities, laboratory data, antimicrobial treatment, and outcomes. Data analysis was conducted with descriptive statistics (chi-square, Fisher’s exact).

Results:

A total of 253 patients had VRE-BSI; 167 treated with L and 60 with D. L and D treated cohorts differed in CHF (L=17/167 v D 13/60, p=0.04), history of MI (L=16/167 v D 13/60, p=0.02), and liver disease (L=82/167 v D 14/60, p<0.001), but did not differ in Horn’s Index, transplant status, or immunosuppression. Among L treated patient, 26/167 were treated with a concomitant SSRI. In unadjusted analysis, L and D did not differ in time to mortality (p=0.88) or inpatient mortality (L 81/167 v D 30/60, O.R. 0.94, p=0.88). Over 25% of patients (64/253) had a change in antibiotic therapy due to lack of effectiveness. L was less commonly changed for lack of effectiveness (40/167 v D 24/60, p=0.03).

Conclusion:

Patients with VRE-BSI have significant morbidity and mortality. Comparative effectiveness analysis of real-world practice are still needed to best define optimal treatment and best clinical practices. Further research is required to better understand changes in antibiotic therapy for patients with VRE-BSI.

James a. Mckinnell, MD1, Samantha J. Eells, MPH2, Patil Injean, BS1, Donald Whang, MD1, Romney Humphries, PhD3 and Aric Gregson, MD4, (1)Infectious Disease Clinical Outcomes Research Unit (IDCORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, CA, (2)Science 37, Culver City, CA, (3)Department of Pathology and Laboratory Medicine, UCLA, Los Angeles, CA, (4)Infectious Disease, David Geffen School of Medicine/University of California, Los Angeles, Los Angeles, CA

Disclosures:

J. A. Mckinnell, None

S. J. Eells, None

P. Injean, None

D. Whang, None

R. Humphries, None

A. Gregson, None

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