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Efficacy and safety of daptomycin versus linezolid treatment in patients with vancomycin-resistant enterococcal bacteraemia: an updated systematic review and meta-analysis.

Abstract

OBJECTIVES

We conducted a systematic review and meta-analysis to re-assess the efficacy and safety of daptomycin compared with linezolid treatment for vancomycin-resistant enterococcal (VRE) bacteraemia and to explore whether high-dose daptomycin is beneficial.

METHODS

PubMed, EMBASE, the Cochrane Library and meeting abstracts were searched from inception to February 2019. Studies evaluating daptomycin and linezolid treatment for VRE bacteraemia were included.

RESULTS

Twenty-two observational studies were identified. We found a non-significant higher mortality (OR, 1.27; 95% CI, 0.99 to 1.63) and significantly lower risk of thrombocytopenia (OR, 0.78; 95% CI, 0.61 to 0.99) with daptomycin compared to linezolid treatment. Clinical response (OR, 0.88; 95% CI, 0.59 to 1.33), microbiological cure (OR, 0.82; 95% CI, 0.53 to 1.28), recurrence of bacteraemia (OR, 0.96; 95% CI, 0.70 to 1.32) and risk of creatine kinase elevation (OR, 0.82; 95% CI, 0.46 to 1.47) were similar for the two agents. In the subgroup analysis of studies focusing on high-dose daptomycin treatment, similar mortality was observed (OR, 0.92; 95% CI, 0.46 to 1.84). Moreover, patients receiving daptomycin tended to show a higher clinical response (OR, 1.61; 95% CI, 0.37 to 7.09) and microbiological cure (OR, 2.09; 95% CI, 0.43 to 10.1) and a lower risk of bacteraemia relapse (OR, 0.47; 95% CI, 0.15 to 1.45), although the difference was not significant.

CONCLUSIONS

Compared to linezolid treatment, daptomycin treatment showed comparable clinical and microbiological outcomes but a lower incidence of thrombocytopenia. Because of the dose-dependent effect observed, high-dose daptomycin should be considered for patients with VRE bacteraemia.

Authors+Show Affiliations

Department of Clinical Pharmacy, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.Department of Respiratory Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.Department of Hematology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.Translational Medicine Research Center, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou, China.Translational Medicine Research Center, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou, China.Department of Clinical Pharmacy, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.Department of Clinical Pharmacology, Translational Medicine Research Center, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China. Electronic address: lnm1013@zju.edu.cn.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31629937

Citation

Shi, Changcheng, et al. "Efficacy and Safety of Daptomycin Versus Linezolid Treatment in Patients With Vancomycin-resistant Enterococcal Bacteraemia: an Updated Systematic Review and Meta-analysis." Journal of Global Antimicrobial Resistance, 2019.
Shi C, Jin W, Xie Y, et al. Efficacy and safety of daptomycin versus linezolid treatment in patients with vancomycin-resistant enterococcal bacteraemia: an updated systematic review and meta-analysis. J Glob Antimicrob Resist. 2019.
Shi, C., Jin, W., Xie, Y., Zhou, D., Xu, S., Li, Q., & Lin, N. (2019). Efficacy and safety of daptomycin versus linezolid treatment in patients with vancomycin-resistant enterococcal bacteraemia: an updated systematic review and meta-analysis. Journal of Global Antimicrobial Resistance, doi:10.1016/j.jgar.2019.10.008.
Shi C, et al. Efficacy and Safety of Daptomycin Versus Linezolid Treatment in Patients With Vancomycin-resistant Enterococcal Bacteraemia: an Updated Systematic Review and Meta-analysis. J Glob Antimicrob Resist. 2019 Oct 17; PubMed PMID: 31629937.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Efficacy and safety of daptomycin versus linezolid treatment in patients with vancomycin-resistant enterococcal bacteraemia: an updated systematic review and meta-analysis. AU - Shi,Changcheng, AU - Jin,Weizhong, AU - Xie,Yaping, AU - Zhou,Dongmei, AU - Xu,Shuang, AU - Li,Qingyu, AU - Lin,Nengming, Y1 - 2019/10/17/ PY - 2019/09/11/received PY - 2019/10/07/revised PY - 2019/10/08/accepted PY - 2019/10/21/entrez PY - 2019/10/21/pubmed PY - 2019/10/21/medline KW - daptomycin KW - high dosage KW - linezolid KW - meta-analysis KW - vancomycin-resistant enterococcal bacteraemia JF - Journal of global antimicrobial resistance JO - J Glob Antimicrob Resist N2 - OBJECTIVES: We conducted a systematic review and meta-analysis to re-assess the efficacy and safety of daptomycin compared with linezolid treatment for vancomycin-resistant enterococcal (VRE) bacteraemia and to explore whether high-dose daptomycin is beneficial. METHODS: PubMed, EMBASE, the Cochrane Library and meeting abstracts were searched from inception to February 2019. Studies evaluating daptomycin and linezolid treatment for VRE bacteraemia were included. RESULTS: Twenty-two observational studies were identified. We found a non-significant higher mortality (OR, 1.27; 95% CI, 0.99 to 1.63) and significantly lower risk of thrombocytopenia (OR, 0.78; 95% CI, 0.61 to 0.99) with daptomycin compared to linezolid treatment. Clinical response (OR, 0.88; 95% CI, 0.59 to 1.33), microbiological cure (OR, 0.82; 95% CI, 0.53 to 1.28), recurrence of bacteraemia (OR, 0.96; 95% CI, 0.70 to 1.32) and risk of creatine kinase elevation (OR, 0.82; 95% CI, 0.46 to 1.47) were similar for the two agents. In the subgroup analysis of studies focusing on high-dose daptomycin treatment, similar mortality was observed (OR, 0.92; 95% CI, 0.46 to 1.84). Moreover, patients receiving daptomycin tended to show a higher clinical response (OR, 1.61; 95% CI, 0.37 to 7.09) and microbiological cure (OR, 2.09; 95% CI, 0.43 to 10.1) and a lower risk of bacteraemia relapse (OR, 0.47; 95% CI, 0.15 to 1.45), although the difference was not significant. CONCLUSIONS: Compared to linezolid treatment, daptomycin treatment showed comparable clinical and microbiological outcomes but a lower incidence of thrombocytopenia. Because of the dose-dependent effect observed, high-dose daptomycin should be considered for patients with VRE bacteraemia. SN - 2213-7173 UR - https://www.unboundmedicine.com/medline/citation/31629937/Efficacy_and_safety_of_daptomycin_versus_linezolid_treatment_in_patients_with_vancomycin-resistant_enterococcal_bacteraemia:_an_updated_systematic_review_and_meta-analysis L2 - https://linkinghub.elsevier.com/retrieve/pii/S2213-7165(19)30262-0 DB - PRIME DP - Unbound Medicine ER -