Study Finds Outcomes Similar in VRE UTI Despite Generation of Antibiotics Used

   According to data presented at the 50th Interscience Conference on Antimicrobial Agents and Chemotherapy, clinical outcomes were similar in patients with vancomycin resistant enterococcus (VRE) urinary tract infections (UTI) whether they were administered newer or older VRE antibiotics.

   Aware that, despite high incidence, the appropriate treatment of nosocomial VRE UTI is unclear, researchers at St. Luke’s Episcopal Hospital in Houston investigated treatment patterns and outcomes of hospitalized patients with VRE UTI based on severity and choice of antibiotic. They performed a retrospective cohort study of hospitalized patients with urine cultures positive for VRE. Patients were stratified by severity of infection (mild vs moderate) and by treatment with newer (linezolid, daptomycin) vs older (ampicillin, tetracyclines, nitrofurantoin) antibiotics. Antibiotic susceptibility and clinical outcomes were assessed.

   One hundred patients with VRE urine cultures were identified. Susceptibility to VRE antibiotics were as follows: linezolid (100%), daptomycin (99%), tetracycline (53%), nitrofurantoin (32%), and ampicillin (19%). The investigators determined that VRE UTI severity was moderate in 68 patients and mild in 32 patients.  Antibiotics were given to 44% of patients with mild disease and 69% of patients with moderate disease (P=0.015).

   New antibiotics were more commonly given to patients with mild (100%) vs moderate (62%) VRE UTI (P=0.0058). Following data analysis, the St. Luke’s researchers found that the average time to symptom resolution and length of hospital stay was similar in patients given newer vs older antibiotics regardless of disease severity. (No patient changed antibiotics during the treatment course.) Of patients that received newer antibiotics, 82% had isolates that were susceptible to at least one older agent.

   As noted, clinical outcomes were similar in patients with VRE UTI infections given newer vs older VRE antibiotics. The investigators commented that their results could have significant impact on antibiotic stewardship opportunities for stepdown or descalation therapy.