702. Efficacy and safety of telavancin in the treatment of Gram-positive bloodstream infections in cancer patients
Session: Poster Abstract Session: Antimicrobials: Novel Agents
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C

Background: Infections caused by gram-positive bacteria, particularly methicillin-resistant Staphylococcus aureus (MRSA), are an important cause of morbidity and mortality in cancer patients. The creeping of vancomycin MICs among MRSA isolates has been associated with poor outcome. Thus, alternative antibiotics covering these pathogens such as Telavancin, a once-daily lipoglycopeptide, displaying strong bactericidal activity against S. aureus and other Gram-positive pathogens are warranted.

Methods: Between March 2011 and March 2013, we evaluated the clinical efficacy and safety of telavancin for treatment of Gram-positive bloodstream infections (BSI) in cancer patients. Patients with uncomplicated Gram-positive BSIs received intravenous telavancin for at least 14 days for Staphylococcus aureus and 7 days for other Gram-positive cocci. Patients with baseline creatinine clearance (Cr Cl) > 50 ml/min received a daily dose of 10mg/kg and those with Cr Cl between 30-49 ml/min received a dose of 7.5 mg/kg. Patients were followed for 1 month after the last dose of study drug.

Results: A total of 36 patients were enrolled.  The majority of patients had hematologic malignancy (61%), solid tumor (43%) and 6 patients (16%) had undergone stem cell transplantation. Eighteen patients (50%) had persistent neutropenia.  The most common pathogens causing BSI were Staphylococcus aureus (n = 18), followed by alpha-hemolytic Streptococci (n=6), Enterococcus (n=6), coagulase-negative Staphylococcus (n=5), and beta-hemolytic Streptococci (n=1). The overall clinical success rate was 88.6% and microbiological eradication rate within 96 hours of study medication initiation was 94%. Drug-related adverse events occurred in 31% of the patients, whereas adverse events sufficient to stop telavancin occurred in 16% with the majority due to renal toxicity. Creatinine level increased by at least double from baseline in 4 patients (12%). However, the creatinine levels of these patients decreased to baseline levels by the end of the follow-up period.

Conclusion: Treatment with telavancin for gram-positive BSI in cancer patients was generally effective and safe and may provide a useful alternative to standard vancomycin therapy.

Ray Hachem, MD1, Anne-Marie Chaftari, MD2, Aline El Zakhem, MD3, George M. Viola, MD, MPH4, Bruno Granwehr, MD5, Andrew Gagel6, Ying Jiang, MS7, Munirah Alshuaibi, MD6 and Issam Raad, MD7, (1)University of Texas M.D. Anderson Cancer Center, Houston, TX, (2)Infectious Diseases, Infection Control & Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, (3)UT MD ANDERSON CANCER CENTER, HOUSTON, TX, (4)Infectious Diseases, The University of Texas MD Anderson Cancer Center, Houston, TX, (5)University of Texas-MD Anderson Cancer Center, Houston, TX, (6)UT MD Anderson Cancer Center, Houston, TX, (7)Infectious Diseases, Infection Control & Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX

Disclosures:

R. Hachem, None

A. M. Chaftari, None

A. El Zakhem, None

G. M. Viola, None

B. Granwehr, None

A. Gagel, None

Y. Jiang, None

M. Alshuaibi, None

I. Raad, American Medical Systems: , Licensing agreement or royalty
Cook: Speaker's Bureau, Grant recipient and Licensing agreement or royalty
ECP: ,
Great Lakes Pharmaceuticals: ,
Inventive Protocol, Inc.: ,
Medline: , Licensing agreement or royalty
TyRx: , Licensing agreement or royalty

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