Impact of the More-Potent Antibiotics Quinupristin-Dalfopristin and Linezolid on Outcome Measure of Patients with Vancomycin-Resistant Enterococcus Bacteremia
Open Access
- 1 January 2008
- journal article
- Published by Oxford University Press (OUP) in Clinical Infectious Diseases
- Vol. 46 (1), 30-36
- https://doi.org/10.1086/523588
Abstract
Background. The impact of antibiotic resistance on the clinical outcome of patients with vancomycin-resistant Enterococcus (VRE) bacteremia remains unclear. There are limited data comparing patient outcomes during the early era of vancomycin resistance with the period of more-potent antibiotic availability. Methods. A retrospective review was conducted of 113 patients with VRE bacteremia at a single institution from August 1993 to September 2005. Patients were assigned to a group on the basis of initial antibiotic choice for treatment of VRE (linezolid, quinupristin-dalfopristin, or combinations of other agents, before newer options were available). Outcome measurements were examined for the initial episode of VRE bacteremia, and multiple logistic regression analysis was performed to compare group outcomes. Results. Overall mortality was 37.2% (42 of 113 patients). VRE bacteremia caused or significantly contributed to death in 29 (69%) of 42 patients. Seventy-one patients were initially treated with linezolid, 20 with quinupristin-dalfopristin, and 22 with combinations of other agents. Univariate analysis indicated significantly more deaths in the quinupristin-dalfopristin group (odds ratio, 5.45; 95% confidence interval, 1.89–15.9) and in the other-agents group (odds ratio, 2.94; 95% confidence interval, 1.09–7.94) than in the linezolid group. However, after adjustment for severity of illness, treatment group was not a significant independent factor. Conclusion. Despite the development of antimicrobial agents with greater potency against VRE, a significant change in clinical outcome was not observed. This suggests that vancomycin resistance does not significantly influence mortality and points to the continued need for prospective, randomized clinical trials.Keywords
This publication has 25 references indexed in Scilit:
- Tigecycline: A new glycylcycline antimicrobial agentAmerican Journal of Health-System Pharmacy, 2006
- Daptomycin-Resistant Enterococcus faecium in a Patient With Acute Myeloid LeukemiaMayo Clinic Proceedings, 2005
- Linezolid for the Treatment of Multidrug‐Resistant, Gram‐Positive Infections: Experience from a Compassionate‐Use ProgramClinical Infectious Diseases, 2003
- Clinical Outcomes for Patients with Bacteremia Caused by Vancomycin?Resistant Enterococcus in a Level 1 Trauma CenterClinical Infectious Diseases, 2002
- Quinupristin/Dalfopristin Therapy for Infections Due to Vancomycin-Resistant Enterococcus faeciumClinical Infectious Diseases, 2000
- Emergence of Increased Resistance to Quinupristin/ Dalfopristin During Therapy for Enterococcus faecium BacteremiaClinical Infectious Diseases, 1997
- Nosocomial Infections with Vancomycin-Resistant Enterococcus fuecium in Liver Transplant Recipients: Risk Factors for Acquisition and MortalityClinical Infectious Diseases, 1996
- Risk Factors for Mortality Associated With Enterococcal Bloodstream InfectionsInfection Control & Hospital Epidemiology, 1996
- Enterococcus faecium and Enterococcus faecalis Bacteremia: Acquisition and OutcomeClinical Infectious Diseases, 1995
- Plasmid-Mediated Resistance to Vancomycin and Teicoplanin in Enterococcus FaeciumNew England Journal of Medicine, 1988