794. Retrospective Study of Linezolid versus Daptomycin for the Treatment of Vancomycin- Resistant Enterococcal Bloodstream Infection 
Session: Poster Abstract Session: Treatment of Resistant Infections - Clinical Analyses
Thursday, October 5, 2017
Room: Poster Hall CD
Background: Due to acquired resistance with Enterococcus, antibiotic therapy for vancomycin-resistant enterococcal (VRE) bloodstream infections (BSI) is limited. Current recommendations for the treatment of VRE BSI include either linezolid or daptomycin. The objective of this study was to compare clinical outcomes of VRE BSI in patients treated with linezolid or daptomycin.

Methods: This was a retrospective cohort study of inpatients from January 2010 to August 2016 conducted at a large academic medical center. Charts for review were selected based on data from the microbiology laboratory. Adult patients (≥ 18 years old) with VRE BSI treated with linezolid or daptomycin for at least 48 hours were included. Patients treated with linezolid and daptomycin combination therapy or any other antimicrobial agents were excluded. The primary outcome measure was 14-day in-hospital mortality. Secondary outcomes included time to blood culture clearance, microbiologic failure, antibiotic failure, and BSI relapse. A multivariable logistic regression model was performed to adjust for potential confounders.

Results: There were a total of 93 patients, 62 treated with linezolid and 31 with daptomycin. Median daptomycin dose was 6.14 mg/kg (IQR, 5.98-6.71). Outcome of 14-day in-hospital mortality was not significantly different for patients treated with linezolid and daptomycin (17.7% vs. 29%, p=0.21, respectively). Median time to blood culture clearance was not significantly different for linezolid versus daptomycin therapy (3.0 days vs. 3.7 days, p = 0.78, respectively). All other secondary outcomes were not significantly different between treatment groups. Multivariate logistic regression analysis indicated 14-day in-hospital mortality was independently associated with Pitt bacteremia score (adjusted OR 1.48, 95% CI: 1.12-1.97) but showed no significant association with daptomycin treatment (adjusted OR 1.54, 95% CI: 0.46-5.14).

Conclusion: There were no significant differences in clinical outcomes for patients treated with linezolid or daptomycin for the treatment of VRE BSI. Additional prospective studies with larger sample sizes are needed to further validate these conclusions. Role of daptomycin dose on outcomes requires further study.

Rena Rai, PharmD Candidate 20191, Parth Vaidya, PharmD Candidate 20201, Avani Desai, MD2, Tanaya Bhowmick, MD3, Melvin Weinstein, MD3 and Navaneeth Narayanan, PharmD, BCPS4, (1)Rutgers University, Ernest Mario School of Pharmacy, Piscataway Township, NJ, (2)Infectious Disease, Rutgers-Robert Wood Johnson University Medical School, New Brunswick, NJ, (3)Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, (4)Division of Infectious Diseases, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ

Disclosures:

R. Rai, None

P. Vaidya, None

A. Desai, None

T. Bhowmick, None

M. Weinstein, None

N. Narayanan, None

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