International Journal of Clinical Pharmacy

, Volume 35, Issue 5, pp 697–703 | Cite as

Treatment considerations in vancomycin-resistant enterococcal bacteremia: daptomycin or linezolid? A review

  • Bhavarth S. ShuklaEmail author
  • Timothy P. Gauthier
  • Ricardo Correa
  • Laura Smith
  • Lilian Abbo
Review Article


Background Vancomycin resistant enterococcal bloodstream infections are an important cause of morbidity and mortality in hospitalized patients. Aim of the Review A search of the literature was undertaken to determine the optimal antimicrobial therapy for the management of vancomycin resistant enterococcal bloodstream infections. Method MEDLINE, EMBASE, and the Cochrane Library (unrestricted to time or language) were searched for studies of vancomycin resistant enterococcal bloodstream infections in adults reporting outcomes of direct comparisons of linezolid versus daptomycin on November 26, 2012. Studies of basic science, reviews, commentaries, pharmacologic, epidemiologic, or pediatric studies, and those studies examining conditions other than enterococcal bacteremia, a single antimicrobial agent or other antimicrobials were excluded. Results 226 studies were screened for eligibility and yielded eight studies evaluating a total of 807 patients. Inter-rater agreement was 100 %. Qualitative evaluation of the studies was performed using the Newcastle–Ottawa scale. No randomized controlled trials were identified. All studies were retrospective cohorts and non-randomized. 458 (57 %) patients treated with linezolid and 349 (43 %) with daptomycin were analyzed. Variable comorbidities and severity of illness were described in the included studies and reported here for comparison. Conclusion The optimal treatment of vancomycin resistant enterococcal bloodstream infections is yet to be determined. Well-designed prospective studies are needed to lend more convincing evidence regarding choice of antimicrobial therapy for this important multidrug resistant organism.


Bloodstream infections Daptomycin Linezolid Mortality Outcomes Vancomycin-resistant enterococci 



The authors would like to thank Dr. Leonardo Tamariz for guidance in data abstraction and preliminary analysis.



Conflicts of interest

None declared.


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Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2013

Authors and Affiliations

  • Bhavarth S. Shukla
    • 1
    • 2
    Email author
  • Timothy P. Gauthier
    • 3
  • Ricardo Correa
    • 1
    • 2
  • Laura Smith
    • 4
  • Lilian Abbo
    • 5
  1. 1.Department of Internal MedicineJackson Memorial HospitalMiamiUSA
  2. 2.Division of Internal Medicine, Department of MedicineUniversity of Miami Miller School of MedicineMiamiUSA
  3. 3.Department of Pharmacy PracticeNova Southeastern University, College of PharmacyFort LauderdaleUSA
  4. 4.Department of PharmacyJackson Memorial HospitalMiamiUSA
  5. 5.Division of Infectious Diseases, Department of MedicineUniversity of Miami Miller School of MedicineMiamiUSA

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