Similar efficacy and safety of daptomycin versus linezolid for treatment of vancomycin-resistant enterococcal bloodstream infections: a meta-analysis

• Systematic review and meta-analysis evaluating efficacy and safety of daptomycin versus linezolid for treatment of VRE-BSI.
• No significant difference found between daptomycin and linezolid regarding overall mortality.
• No significant difference found between daptomycin and linezolid in clinical cure, microbiological cure or relapse rate.
• Daptomycin and linezolid showed similar safety profiles in the treatment of VRE-BSI.

Daptomycin and linezolid are the most commonly used antibiotics for bloodstream infection caused by vancomycin-resistant enterococci (VRE-BSI). However, the best therapeutic agent to treat VRE-BSI remains to be established. In order to provide evidence for an optimal treatment decision, a systematic review and meta-analysis was performed comparing the efficacy and safety of daptomycin and linezolid for the treatment of VRE-BSI. After thorough searching of relevant studies from MEDLINE, EMBASE, Clinicaltrials.gov and international meetings up to November 2015, 11 retrospective cohort studies were finally included with a sample size of 1339 patients. Among these 11 included studies, all patients in the daptomycin group received standard or high-dose daptomycin treatment (≥6 mg/kg/day). Data were extracted and pooled risk ratios (RRs) and 95% confidence intervals (95% CIs) were calculated using a random-effects model. The meta-analysis indicated similar crude overall mortality between patients receiving daptomycin and those treated with linezolid (RR = 1.07, 95% CI 0.83–1.37). Moreover, no difference regarding clinical cure (RR = 1.11, 95% CI 0.88–1.42), microbiological cure (RR = 0.99, 95% CI 0.90–1.09) or relapse rate of VRE-BSI (RR = 1.08, 95% CI 0.76–1.52) was found between daptomycin and linezolid. Adverse event rates were not significantly different between the two groups. Currently available evidence indicates similar efficacy and safety of daptomycin and linezolid for the treatment of VRE-BSI. However, the findings in the meta-analysis are limited by heterogeneity between relatively small-scale retrospective studies and should be interpreted cautiously.