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Linezolid to treat urinary tract infections caused by vancomycin-resistant Enterococcus
Benjamin Alan Pontefract1,2, Suzette Amy Rovelsky2, Karl Joseph Madaras-Kelly2,3
1College of Pharmacy, Ferris State University, Big Rapids, MI, USA.
Background:
Vancomycin-resistant Enterococcus can cause urinary tract infection. Linezolid possesses antimicrobial activity against vancomycin-resistant Enterococcus but has limited urinary excretion. Minimal data demonstrate efficacy of linezolid for treatment of urinary tract infections.
Objective:
The main aim of this study is to compare post-treatment outcomes of linezolid to other antibiotics with vancomycin-resistant Enterococcus activity in the treatment of urinary tract infection caused by vancomycin-resistant Enterococcus.
Methods:
A retrospective cohort of inpatients within Veterans Health Administration facilities with urinary tract infection caused by vancomycin-resistant Enterococcus was created. Patients with vancomycin-resistant Enterococcus isolated from urine cultures and chart documentation meeting criteria for urinary tract infection were identified. Demographics, comorbidity, treatments, and post-treatment outcomes were extracted from the electronic health record. Outcomes were compared between patients treated with linezolid and alternative antibiotics possessing vancomycin-resistant Enterococcus activity 14 days after treatment completion. Logistic regression adjusted for covariates associated with each outcome.
Results:
Of 4,683 patients with a positive vancomycin-resistant Enterococcus culture, 624 (13%) met criteria for chart review, and 92 (15%) had documentation of urinary tract infection symptoms and treatment. The primary reason for exclusion was asymptomatic bacteriuria (64%). Patients had high Charlson Comorbidity Scores (mean = 8.7; standard deviation (SD) = 3.3), and 70% were located on general medical/surgical wards on the day of culture collection. Linezolid was prescribed in 54 (59%) cases. No difference between linezolid and comparator antibiotics were observed in re-initiation of antibiotics for vancomycin-resistant Enterococcus urinary tract infection (9% and 5% respectively (p = 0.56), (adjusted odds ratio (OR) = 1.90; 95% confidence interval (CI) = 0.34-10.63)), recurrent positive vancomycin-resistant Enterococcus culture (4% and 11%, respectively (p = 0.23), (adjusted OR = 0.36; 95% CI = 0.05-2.31)), or mortality (7% and 3%, respectively (p = 0.39) (adjusted OR = 2.96; 95% CI = 0.37-41.39)).
Conclusion:
Most patients with vancomycin-resistant Enterococcus identified on urine culture were asymptomatic. Linezolid appears effective as comparator antibiotics for the treatment of mild vancomycin-resistant Enterococcus urinary tract infection.
Insights
Linezolid is effective for treating vancomycin-resistant Enterococcus urinary tract infections, showing similar outcomes to other antibiotics. Most patients with VRE in urine cultures were asymptomatic, indicating linezolid
Area of Science:
- Infectious Diseases
- Pharmacology
- Urology
Background:
- Vancomycin-resistant Enterococcus (VRE) is a significant cause of urinary tract infections (UTIs).
- Linezolid exhibits antimicrobial activity against VRE but has limited urinary excretion, raising questions about its efficacy in UTIs.
- Limited data exist on the effectiveness of linezolid for treating VRE UTIs.
Purpose of the Study:
- To compare the post-treatment outcomes of linezolid with other antibiotics active against VRE in patients with VRE UTIs.
- To evaluate the efficacy of linezolid in the context of VRE UTIs within a real-world clinical setting.
Main Methods:
- A retrospective cohort study was conducted using data from Veterans Health Administration facilities.
- Patients with VRE isolated from urine cultures and meeting UTI criteria were identified.
- Outcomes were compared between patients treated with linezolid and alternative VRE-active antibiotics 14 days post-treatment, with logistic regression used for adjusted analyses.
Main Results:
- Of 4,683 VRE-positive urine cultures, 92 patients met UTI criteria; 64% were excluded for asymptomatic bacteriuria.
- Patients had high comorbidity scores (mean Charlson Comorbidity Score = 8.7).
- No significant differences were observed between linezolid and comparator antibiotics regarding antibiotic re-initiation, recurrent VRE UTI, or mortality.
Conclusions:
- The majority of patients with VRE identified in urine cultures were asymptomatic.
- Linezolid demonstrated comparable effectiveness to other antibiotics for treating mild VRE UTIs.
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