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.