Program Schedule

673
Comparative Effectiveness of Vancomycin versus Early Daptomycin for MRSA Bacteremia with Vancomycin MIC >1 mg/L: A Multicenter Evaluation

Session: Poster Abstract Session: Approach to Clinical Infections
Friday, October 10, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Posters
  • DAP_vs_VAN_for_HighMIC_MASS_Poster-673_IDSA_Final_2014.pdf (149.9 kB)
  • Background: Evidence suggests that vancomycin has reduced effectiveness in MRSA bacteremia with higher vancomycin MIC values (> 1 mg/L). However, clinical studies comparing vancomycin to alternative therapy in these patients are limited.

    Methods: We conducted a retrospective, nationwide, multicenter, matched (by age, bacteremia type, severity of illness, ID consult and institution), cohort study that compared daptomycin versus vancomycin among adult patients with MRSA bacteremia with high vancomycin MICs (1.5-2 mg/L). The primary outcome was composite failure, defined as having: 60-day all-cause mortality, 7-day clinical or microbiological failure, failure at end of therapy, and/or 30-day BSI relapse. Secondary outcomes included early bacteremia clearance by day 4 without recurrence and acute kidney injury (AKI). Stratified treatment-outcomes analyses by key baseline covariates were performed.

    Results: One hundred seventy patients from 11 United States institutions were included. The median daptomycin dose was 6 mg/kg (interquartile, IQ, range, 6-8 mg/kg). Daptomycin was dosed >8 mg/kg in 26% (22/85). All patients had vancomycin troughs of at least 10 mg/L (median 17.5 mg/L; IQ range, 14.0-22.0 mg/L). Vancomycin troughs were >15 mg/L in 71% (60/85). The primary composite endpoint did not vary between the daptomycin and vancomycin groups (31% vs. 39%, respectively, P = 0.259). Both end of therapy failure and acute kidney injury were significantly lower in the daptomycin relative to the vancomycin group (11% vs 24%, respectively, P = 0.025, and 9% vs 23%, respectively, P = 0.043). In the stratified analyses, daptomycin demonstrated a higher rate of bacteremia clearance by day 4 than vancomycin (94% vs 56%, respectively, P = 0.035) among immunocompromised patients (n=26).

    Conclusion: Results from this multicenter study provide real-world comparative data on the outcomes with daptomycin vs vancomycin in adult patients with MRSA bacteremia with vancomycin MIC 1.5-2 mg/L. As with all observational studies, these findings should be interpreted cautiously.

    Pamela Moise, PharmD1, Darren Culshaw, PharmD1, Annie Wong-Beringer, PharmD2, Joyce Bensman, PharmD3, Kenneth Lamp, PharmD1, Winter J. Smith, PharmD4, Karri Bauer, PharmD5, Debra Goff, PharmD5, Robert Adamson, PharmD6, Kimberly Leuthner, PharmD7, Michael Virata, MD8, James a. Mckinnell, MD9,10, Saira B. Chaudhry, PharmD, MPH11, Romic Eskandarian, PharmD12, Thomas Lodise, PharmD13, Katherine Reyes, MD14 and Marcus Zervos, MD14, (1)Cubist Pharmaceuticals, Lexington, MA, (2)Huntington Hosp, Los Angeles, CA, (3)University of Southern California, Los Angeles, CA, (4)University of Oklahoma Health Sciences Center, Oklahoma City, OK, (5)The Ohio State University Medical Center, Columbus, OH, (6)St. Barnabas Health Care System, Livingston, NJ, (7)University Medical Center of Southern Nevada, Las Vegas, NV, (8)Hospital of Saint Raphael, New Haven, CT, (9)Torrance Memorial Medical Center, Torrance, CA, (10)Infectious Disease Clinical Outcomes Research Unit (ID-CORE) at Los Angeles Biomedical Research Institute, Torrance, CA, (11)Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Piscataway, NJ, (12)Glendale Adventist Medical Center, Glendale, CA, (13)Albany College of Pharmacy, Albany, NY, (14)Henry Ford Hospital, Detroit, MI

    Disclosures:

    P. Moise, Cubist: Employee and Shareholder, Salary

    D. Culshaw, Cubist: Employee and Shareholder, Salary

    A. Wong-Beringer, None

    J. Bensman, None

    K. Lamp, Cubist Pharmaceuticals: Employee and Shareholder, Salary

    W. J. Smith, None

    K. Bauer, None

    D. Goff, None

    R. Adamson, None

    K. Leuthner, None

    M. Virata, None

    J. A. Mckinnell, None

    S. B. Chaudhry, None

    R. Eskandarian, None

    T. Lodise, Cubist Pharmaceuticals: Consultant, Consulting fee

    K. Reyes, None

    M. Zervos, None

    Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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