Outcomes of therapy: vancomycin-resistant enterococcal bacteremia in hematology and bone marrow transplant patients

The purpose of this study was to evaluate the risk factors associated with the treatment failure and 30-day mortality in hematology and bone marrow transplant patients treated with daptomycin or linezolid for vancomycin-resistant enterococci (VRE) bacteremia. The safety and tolerability of therapy was also assessed.

This single-center, retrospective study included adult patients admitted to the hematology or bone marrow transplant service with documented vancomycin-resistant Enterococcus faecium or Enterococcus faecalis bacteremia and received at least 48 h of either linezolid or daptomycin as primary treatment. Clinical and microbiologic outcomes were assessed at day 7, 14, and 30 of hospital stay.

A total of 72 patients were included in the analysis. Forty-three patients received daptomycin as primary treatment and 29 received linezolid as primary treatment. Overall success rate at day 7 was 81.9%, day 14 success rate was 79.2%, and day 30 success rate was 76.4% for all patients. Forty-one patients (57.0%) had high-grade bacteremia defined as greater than one positive blood culture for VRE. The mortality rate was significantly higher if high-grade bacteremia was present (34.1% vs. 7.0%; p = 0.009).

This study suggests that linezolid and daptomycin are both reasonable options for treating VRE bacteremia in hematology and bone marrow transplant patients; however, patients with high-grade VRE bacteremia may be at increased risk for treatment failure.