Disposition of linezolid or daptomycin in Enterococcal bloodstream infections according to vancomycin resistant Enterococcus colonization.

Elizabeth Short,Milena Mclaughlin,John Esterly,Jeannie Ong,Michael Postelnick

doi:10.1186/2047-2994-3-37

Abstract

Vancomycin resistant Enterococcus (VRE) colonized patients are likely to receive VRE targeted Gram-positive antibiotics and may not be de-escalated appropriately once final cultures are available. A retrospective cohort study was conducted in VRE-colonized and non-VRE colonized patients with Enterococcal bloodstream infections. Of 101 patients (n = 50 VRE-colonized; n = 51 non-colonized), empiric therapy with linezolid or daptomycin was started more often in VRE-colonized than non-colonized patients (n = 8, 15.5% vs n = 27, 54%, p < 0.01). There was no difference in de-escalation once VRE infection was ruled out (non-colonized, n = 2, 66.7% vs VRE-colonized, n = 2, 50%, p = 0.09). This study encourages continued stewardship vigilance to decrease inappropriate antibiotic use.

Highlights

Enterococcus is a common cause of nosocomial infections, and the incidence of vancomycin resistant Enterococcus (VRE) infection continues to rise [1,2]
Our study found that the incidence of VRE bloodstream infection (BSI) was significantly greater in the VRE-colonized group compared to the non-colonized group
While approximately half of the VRE-colonized patients were empirically started on linezolid or daptomycin, only 50% of those eligible were appropriately de-escalated

Summary

Introduction

Enterococcus is a common cause of nosocomial infections, and the incidence of vancomycin resistant Enterococcus (VRE) infection continues to rise [1,2]. Patients with VRE infection incur an increased cost of care of $27, 190 compared to patients with vancomycin-susceptible Enterococcus (VSE) infection [3]. Patients with an Enterococcal bloodstream infection (BSI) who are VRE-colonized frequently receive empiric Grampositive antibiotics targeted against VRE, such as linezolid or daptomycin. Finalized cultures growing VSE may warrant appropriate antibiotic de-escalation, which is a critical stewardship issue. We sought to determine the percent of patients with an Enterococcal BSI initially started on linezolid or daptomycin whose therapy was de-escalated once finalized culture data is available

Methods

Results

Conclusion