355. Vancomycin Experience in Physician Office Infusion Centers
Session: Poster Abstract Session: MRSA, MSSA, Enterococci
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
  • Vancomycin_Experience_in_Physician_Office_Infusion_Centers.pdf (374.8 kB)
  • Background:  Vancomycin (VAN) has been used in physician office infusion centers (POICs) in patients (pts) with a variety of gram-positive infections.  The assessments of patients in the POIC setting may allow for optimal monitoring of outpatient VAN therapy and early recognition of adverse events.  We describe the clinical course of pts treated with vancomycin in POICs.

    Methods:  The medical records were queried of the first 25 pts from 4 POICs that treated pts with VAN during June to December, 2012.  Data included demographics, diagnosis, organisms, pertinent laboratory data, assessment of creatinine clearance, therapy regimen, adverse events, and clinical outcomes.  Therapeutic range for VAN was defined as 15-20 mg/dL.  Clinical success was defined as cure or improved. Cure was defined as resolution of disease and negative laboratory results when available. Improved was defined as partial resolution with continuation of oral antibiotics or other intervention.

    Results:  100 patients were evaluated.  51 pts were female; mean age was 56 years (range 6-78).  Infections included 52 complicated skin and soft tissue, 26 bone and joint, 11 blood stream infection, 7 respiratory infections, 2 intra-abdominal infection, and 2 urinary tract infections.  Mean initial VAN dose was 13.7 mg/kg (range 7.3-31.4).  Mean length of therapy was 24 days (range 4-88).  Culture data was available in 75 pts with several mixed infections.  Predominant pathogens included 44 methicillin-resistant Staphylococcus aureus and 13 coagulase-negative staphylococci. 99 pts had at least 2 serum creatinine (SCR) levels for comparison.  82 pts had at least 2 VAN troughs for comparisons.  2 pts had an increase in SCR of 0.5 mg/dL or more; 1 pt had an elevated VAN trough.  Overall VAN clinical treatment success was 82%, with 56 cured and 26 improved.  7 pts failed and switched therapy due to adverse events, including neutropenia, eosinophilia, respiratory distress, increased SCR, myalgia, nausea, and rash/itching. 11 were non-evaluable for VAN therapy due to transfer of care (5), or antibiotic change due to culture results or clinical preference (6).

    Conclusion:  VAN was used for a variety of infections in POICs with positive outcomes and few adverse events experienced by pts requiring discontinuation.  VAN appears to be an effective and well-tolerated therapy in POICs.

    Ramesh V. Nathan, MD, FIDSA1, Richard C. Prokesch, MD, FACP, FIDSA2, John S. Adams, MD, FIDSA, FSHEA3, Quyen Luu, MD4, Kimberly a. Couch, PharmD, MA5 and Lucinda J. Van Anglen, PharmD5, (1)Mazur, Statner, Dutta, Nathan, PC, Thousand Oaks, CA, (2)Infectious Diseases Associates, Riverdale, GA, (3)Knoxville Infectious Disease Consultants, P.C., Knoxville, TN, (4)Quyen Luu, MD, Macon, GA, (5)Healix Infusion Therapy, Inc., Sugar Land, TX


    R. V. Nathan, Optimer: Speaker's Bureau , Speaker honorarium
    Cubist: Speaker's Bureau , Speaker honorarium

    R. C. Prokesch, None

    J. S. Adams, Diatherix Laboratories: Scientific Advisor , Consulting fee
    Healix: Management company , Shared revenue

    Q. Luu, None

    K. A. Couch, None

    L. J. Van Anglen, Merck: Investigator , Research grant

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.