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題名 Daptomycin versus linezolid for the treatment of vancomycin-resistant enterococcal bacteraemia: implications of daptomycin dose
作者 Chuang, Y.-C.;Lin, H.-Y.;Chen, P.-Y.;Lin, C.-Y.;Wang, J.-T.;Chang, S.-C.
林馨怡
貢獻者 經濟系
關鍵詞 Bacteraemia; Daptomycin; Linezolid; Outcome; Vancomycin-resistant enterococci
日期 2016-10
上傳時間 15-十二月-2016 16:10:35 (UTC+8)
摘要 Treatment options for vancomycin-resistant enterococci (VRE) bloodstream infection are limited. Studies comparing daptomycin or linezolid in treating VRE bloodstream infection have conflicting results and suggest daptomycin underdosing. The responses to different daptomycin doses have not been studied. We conducted a multicentre prospective cohort study to compare linezolid and daptomycin (≥6 mg/kg) for the treatment of VRE bloodstream infection. The primary outcome was 14-day mortality. We used multivariate logistic regression analysis for outcome analysis and a generalized additive model for dose-dependent response estimation. Two hundred twelve patients were included (daptomycin, n = 141; linezolid, n = 71). All-cause 14-day mortality was higher in the daptomycin group (36.9% vs. 21.1%; p 0.03). After adjusting for confounders in logistic regression, mortality was lower in the linezolid group (adjusted odds ratio (aOR), 0.45; 95% confidence interval (CI), 0.21–0.96; p 0.04). The generalized additive model showed that higher-dose daptomycin (≥9 mg/kg) was associated with better survival than lower-dose daptomycin (6–9 mg/kg). Logistic regression showed that linezolid (aOR, 0.36; 95% CI, 0.17–0.79; p 0.01) and higher-dose daptomycin (aOR, 0.26; 95% CI, 0.09–0.74; p 0.01) independently predicted lower mortality compared to lower-dose daptomycin. Linezolid was not superior to higher-dose daptomycin in terms of mortality (aOR, 1.40; 95% CI, 0.45–4.37; p 0.57). Higher-dose daptomycin had lower mortality than lower-dose daptomycin. Despite higher mortality for lower-dose daptomycin than linezolid, linezolid conferred no survival benefit compared to higher-dose daptomycin. Our findings suggest that the recommended daptomycin dose is suboptimal for treating VRE bacteraemia.
關聯 Clinical Microbiology and Infection, Volume 22, Issue 10, October 2016, Pages 890.e1–890.e7
資料類型 article
DOI http://dx.doi.org/10.1016/j.cmi.2016.07.018
dc.contributor 經濟系-
dc.creator (作者) Chuang, Y.-C.;Lin, H.-Y.;Chen, P.-Y.;Lin, C.-Y.;Wang, J.-T.;Chang, S.-C.-
dc.creator (作者) 林馨怡zh_TW
dc.date (日期) 2016-10-
dc.date.accessioned 15-十二月-2016 16:10:35 (UTC+8)-
dc.date.available 15-十二月-2016 16:10:35 (UTC+8)-
dc.date.issued (上傳時間) 15-十二月-2016 16:10:35 (UTC+8)-
dc.identifier.uri (URI) http://nccur.lib.nccu.edu.tw/handle/140.119/104946-
dc.description.abstract (摘要) Treatment options for vancomycin-resistant enterococci (VRE) bloodstream infection are limited. Studies comparing daptomycin or linezolid in treating VRE bloodstream infection have conflicting results and suggest daptomycin underdosing. The responses to different daptomycin doses have not been studied. We conducted a multicentre prospective cohort study to compare linezolid and daptomycin (≥6 mg/kg) for the treatment of VRE bloodstream infection. The primary outcome was 14-day mortality. We used multivariate logistic regression analysis for outcome analysis and a generalized additive model for dose-dependent response estimation. Two hundred twelve patients were included (daptomycin, n = 141; linezolid, n = 71). All-cause 14-day mortality was higher in the daptomycin group (36.9% vs. 21.1%; p 0.03). After adjusting for confounders in logistic regression, mortality was lower in the linezolid group (adjusted odds ratio (aOR), 0.45; 95% confidence interval (CI), 0.21–0.96; p 0.04). The generalized additive model showed that higher-dose daptomycin (≥9 mg/kg) was associated with better survival than lower-dose daptomycin (6–9 mg/kg). Logistic regression showed that linezolid (aOR, 0.36; 95% CI, 0.17–0.79; p 0.01) and higher-dose daptomycin (aOR, 0.26; 95% CI, 0.09–0.74; p 0.01) independently predicted lower mortality compared to lower-dose daptomycin. Linezolid was not superior to higher-dose daptomycin in terms of mortality (aOR, 1.40; 95% CI, 0.45–4.37; p 0.57). Higher-dose daptomycin had lower mortality than lower-dose daptomycin. Despite higher mortality for lower-dose daptomycin than linezolid, linezolid conferred no survival benefit compared to higher-dose daptomycin. Our findings suggest that the recommended daptomycin dose is suboptimal for treating VRE bacteraemia.-
dc.format.extent 107 bytes-
dc.format.mimetype text/html-
dc.relation (關聯) Clinical Microbiology and Infection, Volume 22, Issue 10, October 2016, Pages 890.e1–890.e7-
dc.subject (關鍵詞) Bacteraemia; Daptomycin; Linezolid; Outcome; Vancomycin-resistant enterococci-
dc.title (題名) Daptomycin versus linezolid for the treatment of vancomycin-resistant enterococcal bacteraemia: implications of daptomycin dose-
dc.type (資料類型) article-
dc.identifier.doi (DOI) 10.1016/j.cmi.2016.07.018-
dc.doi.uri (DOI) http://dx.doi.org/10.1016/j.cmi.2016.07.018-