389. Effect of Age and Baseline Bacteremia Status on the Outcomes and Mortality of Hospital-acquired Pneumonia in the ATTAIN Studies
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Mortality is an important outcome in trials of treatments for hospital-acquired pneumonia (HAP). In a recent meta-analysis of community-acquired pneumonia studies, advanced age and presence of bacteremia at baseline were important risk factors for poor outcome.1 We assessed the contribution of age and bacteremia at baseline on clinical outcome, and mortality in the Assessment of Telavancin for Treatment of Hospital-Acquired Pneumonia (ATTAIN) studies.
Methods: ATTAIN 1 and 2 were methodologically identical, randomized, double-blind, parallel-group, Phase 3 trials comparing telavancin and vancomycin for the treatment of HAP due to Gram-positive pathogens. This analysis examined the rates of clinical cure (as defined in the study protocol) and mortality in the all-treated (AT) population (randomized patients who received ≥1 dose of study medication) by patient age, bacteremia status and Acute Physiology and Chronic Health Evaluation (APACHE) II scores at baseline.
Results: 1503 patients were included in the AT population of the ATTAIN trials. Presence of bacteremia was significantly associated with both poor clinical response (p<0.01) and increased mortality (p<0.01), controlling for age and APACHE II score. Advanced age was also significantly associated with increased mortality (p<0.01), controlling for the presence of bacteremia and APACHE II score (Table).
Conclusions: These data support the importance of patient age and presence of bacteremia on the clinical outcome and mortality in HAP.
Patient age<65 y≥ 65 y
Bacteremia status, (n)- (628)+ (70)- (735)+ (70)
APACHE II score, mean (SD)13 (5.8)16 (6.4)17 (5.7)18 (5.7)
Cure rate, % (n)66 (415)49 (34)56 (414)39 (27)
Mortality, % (n)11 (72)19 (13)23 (172)47 (33)

SD, Standard deviation
1. Fleming TR, Powers JH. Clin Infect Dis 2008; 47:S108-20.
Steven Barriere1, G Corey, MD2, Fredric Genter, PhD1, Galia Rahav, MD3, Ethan Rubinstein, MD, L.LB and  S. L. Barriere,
Theravance, Inc. Role(s): Employee, Received: Salary.
E. Rubinstein,
Bayer Role(s): Consultant, Received: Consulting Fee.
Johnson & Johnson Role(s): Consultant, Received: Consulting Fee.
Pfizer Role(s): Consultant, Received: Consulting Fee.
Theravance, Inc. Role(s): Consultant, Received: Consulting Fee.
Astellas Pharma US, Inc. Role(s): Consultant, Received: Consulting Fee.
WYETH PHARMACEUTICALS Role(s): Consultant, Received: Consulting Fee.
Bion Vax Role(s): Consultant, Received: Consulting Fee.
Atox Role(s): Consultant, Received: Consulting Fee.
F. C. Genter,
Theravance, Inc. Role(s): Employee, Received: Salary.
G. R. Corey,
Theravance, Inc. Role(s): Consultant, Grant Investigator, Scientific Advisor (Review Panel or Advisory Committee), Received: Grant Recipient, Consulting Fee.
Astellas Pharma US, Inc. Role(s): Consultant, Scientific Advisor (Review Panel or Advisory Committee), Received: Consulting Fee.
AstraZeneca Role(s): Consultant, Scientific Advisor (Review Panel or Advisory Committee), Received: Consulting Fee.
Cerexa, Inc. Role(s): Consultant, Grant Investigator, Scientific Advisor (Review Panel or Advisory Committee), Received: Grant Recipient, Consulting Fee.
Merck and Co, Inc. Role(s): Consultant, Grant Investigator, Scientific Advisor (Review Panel or Advisory Committee), Received: Grant Recipient, Consulting Fee.
Cempra Pharmaceuticals, Inc. Role(s): Consultant, Grant Investigator, Scientific Advisor (Review Panel or Advisory Committee), Received: Grant Recipient, Consulting Fee.
Innocoll Pharmaceuticals Role(s): Grant Investigator, Received: Research Grant.
Cubist Pharmaceuticals Role(s): Consultant, Scientific Advisor (Review Panel or Advisory Committee), Received: Consulting Fee.
G. Rahav, None., (1)Theravance, Inc., South San Francisco, CA, (2)Duke Clinical Research Institute, Durham, NC, (3)Sheba Medical Center