Comparative-Effectiveness of Ceftaroline and Daptomycin as First-line Therapy for Patients with Skin and Soft Tissue Infections Admitted to Hospitals in the United States Veterans Health Care System

Background: Skin and soft tissue infections are a common cause of hospital admission and readmission. This study compared health outcomes for patients who received first-line ceftaroline or daptomycin for their skin and soft tissue infection.

Methods: This was a retrospective, cohort, comparative-effectiveness study of adults (age 18+ years), admitted to hospitals in the United States Veterans Health Care System with skin and soft tissue infections (by ICD9 codes), between 10/1/10-9/30/14, and who received ceftaroline or daptomycin as first-line therapy within 14 days of admission. Patients who received both drugs were excluded. Chi-square, Fisher's exact, and Wilcoxon rank sum tests were used to compare baseline characteristics. Multivariable logistic regression models were used to compare health outcomes. Model covariates were variables present in >5% of patients with p-values <0.05 in bivariable analysis.

Results: A total of 451 patients were included (ceftaroline=129 and daptomycin=322). Ceftaroline patients were older, more likely to be Hispanic, had higher Charlson comorbitidy scores, and were more likely to have a history of heart failure, chronic obstructive pulmonary disease, diabetes, dyslipidemia, hospital admission, and antibiotic use. Median (25th-75th percentile) time from hospital admission to study drug initiation was 0 (0-1) days for ceftaroline and 1 (0-1) day for daptomycin. Unadjusted emergency department admission rates for ceftaroline versus daptomycin were: 30-day (20% vs. 20%), 60-day (30% vs. 27%), and 90-day (37% vs. 32%). Unadjusted hospital readmission rates were: 30-day (33% vs. 35%), 60-day (36% vs. 40%), and 90-day (40% vs. 43%). Unadjusted mortality rates were: 30-day (1% vs. 3%), 60-day (1% vs. 5%), and 90-day (4% vs. 6%). In multivariable models, ceftaroline patients were less likely than daptomycin patients to experience 60-day patient mortality (OR=0.14, 95%CI=0.01-0.76); 30/60/90-day emergency department admission, 30/60/90-day hospital readmission, and 30/90-day mortality were similar.

Conclusion: In this population, ceftaroline and daptomycin were associated with similar health outcomes for most study endpoints when used as first-line therapy for skin and soft tissue infections.