From the Guidelines
The treatment for Vancomycin-Resistant Enterococci (VRE) urinary tract infection typically involves linezolid (600 mg orally or IV twice daily for 7-14 days) or daptomycin (6-8 mg/kg IV once daily for 7-14 days).
Treatment Options
- Linezolid 600 mg IV or PO every 12 h is recommended for enterococcal infection, including VRE UTI, with treatment duration dependent on the site of infection and clinical response 1.
- For uncomplicated VRE UTIs, alternative options include:
Considerations
- Treatment choice should be guided by susceptibility testing, as VRE strains vary in their resistance patterns.
- For complicated VRE UTIs, such as those involving pyelonephritis or bacteremia, longer treatment courses of 10-14 days are recommended 1.
- Removal of urinary catheters when possible is crucial, as they serve as a reservoir for infection.
- Adequate hydration should be maintained throughout treatment.
- VRE infections are challenging because these bacteria have developed resistance to vancomycin, which is typically effective against gram-positive organisms, necessitating these alternative antimicrobial approaches.
Duration of Treatment
- The duration of treatment should be individualized according to infection sites, source control, the underlying comorbidities, and the initial response to therapy 1.
From the FDA Drug Label
The cure rates for the ITT population with documented vancomycin-resistant enterococcal infection at baseline are presented in Table 15 by source of infection. Urinary tract 12/19 (63) 12/20 (60)
The treatment for Vancomycin-Resistant Enterococci (VRE) Urinary Tract Infection (UTI) is Linezolid. The cure rate for Linezolid in treating VRE UTI is 63% 2.
From the Research
Treatment Options for VRE UTI
- The treatment for Vancomycin-Resistant Enterococci (VRE) Urinary Tract Infection (UTI) depends on various factors, including the severity of the infection and the patient's overall health 3.
- Several antimicrobials have been discussed as potential treatment options for VRE UTIs, including ampicillin, daptomycin, doxycycline, fosfomycin, linezolid, and nitrofurantoin 3, 4.
- Ampicillin is generally considered the drug of choice for ampicillin-susceptible enterococcal UTIs, including VRE 3.
- Nitrofurantoin, fosfomycin, and doxycycline have intrinsic activity against enterococci, including VRE, and are possible oral options for VRE cystitis 3.
- Linezolid and daptomycin should be reserved for confirmed or suspected upper and/or bacteremic VRE UTIs among ampicillin-resistant strains 3.
Comparison of Daptomycin and Linezolid
- Studies have compared the effectiveness of daptomycin and linezolid for the treatment of VRE bacteremia, with conflicting results 5, 6, 7.
- A meta-analysis found that linezolid treatment for VRE bacteremia was associated with a lower mortality than daptomycin treatment, but the results should be interpreted cautiously due to limitations inherent to retrospective studies and high heterogeneity among studies 5.
- Another study found that higher-dose daptomycin (≥9 mg/kg) was associated with better survival than lower-dose daptomycin (6-9 mg/kg), and that linezolid was not superior to higher-dose daptomycin in terms of mortality 6.
- A meta-analysis found similar efficacy and safety of daptomycin and linezolid for the treatment of VRE bloodstream infections, but the findings are limited by heterogeneity between relatively small-scale retrospective studies 7.
Considerations for Treatment
- Clinicians need to differentiate between VRE-associated urinary colonization, asymptomatic bacteriuria, and UTIs in order to determine the need for treatment, optimal therapeutic options, and length of therapy 3.
- Unnecessary use of antibiotics in patients simply colonized and not infected with VRE in the urine has become a large problem in both hospitals and long-term care facilities 3.
- The role of antimicrobial combinations that have shown in vitro or animal-model in vivo efficacy has yet to be established 4.
- Strategies to suppress or eradicate the VRE intestinal reservoir have been reported, including the combination of oral doxycycline plus bacitracin and oral ramoplanin 4.