This retrospective study (SAVE study) compared treatment failure and mortality in patients with vancomycin-susceptible *Enterococcus faecium* bloodstream infection (VSE-BSI) treated with linezolid or daptomycin (n=83) versus vancomycin (n=134) across 3 French hospitals from November 2015 to April 2023.
Overall treatment failure was 54% and did not differ significantly between groups (52% vancomycin vs. 57% linezolid/daptomycin; OR 1.22, 95% CI 0.57–2.62, p=0.61). Unadjusted 30-day mortality was higher with linezolid/daptomycin (45% vs. 28%; RR 1.57, p=0.02), but this difference disappeared after adjustment for confounders (HR 0.6, 95% CI 0.40–1.00, p=0.07). Sepsis (OR 3.11) and elevated baseline CRP (OR 1.01 per unit) were independent risk factors for treatment failure.
- Retrospective design with residual confounding likely, as sicker patients were preferentially assigned to linezolid/daptomycin. - Linezolid and daptomycin were analyzed as a combined group, masking potential heterogeneity between these agents. - Single-country, 3-hospital study limits generalizability.
When vancomycin is not suitable (e.g., nephrotoxicity), linezolid or high-dose daptomycin appear to be reasonable alternatives for VSE-BSI—neither was independently linked to worse outcomes. Clinicians should weigh residual confounding and avoid treating these agents as interchangeable without further comparative data.
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