Disposition of linezolid or daptomycin in Enterococcal bloodstream infections according to vancomycin resistant Enterococcus colonization

Vancomycin resistant Enterococcus (VRE) colonized patients are likely to receive VRE targeted Gram-positive antibiotics and may not be de-escalated appropriately once final cultures are available. A retrospective cohort study was conducted in VRE-colonized and non-VRE colonized patients with Enterococcal bloodstream infections. Of 101 patients (n = 50 VRE-colonized; n = 51 non-colonized), empiric therapy with linezolid or daptomycin was started more often in VRE-colonized than non-colonized patients (n = 8, 15.5% vs n = 27, 54%, p < 0.01). There was no difference in de-escalation once VRE infection was ruled out (non-colonized, n = 2, 66.7% vs VRE-colonized, n = 2, 50%, p = 0.09). This study encourages continued stewardship vigilance to decrease inappropriate antibiotic use.