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 bacteremia and/or sepsis (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 study 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 patient outcomes. Model covariates were those factors with p-values <0.05 in bivariable analysis.
Results: A total of 409 patients were included (ceftaroline=67 and daptomycin=342). Ceftaroline patients were older, more likely to be Black, had higher Charlson comorbitidy scores, and were more likely to have a history of diabetes with complications. Median (25th-75th percentile) time from hospital admission to study drug initiation was 1 (0-1) day for ceftaroline and 1 (1-3) day for daptomycin. Unadjusted hospital readmission rates for ceftaroline versus daptomycin were: 30-day (25% vs. 37%, p=0.0597), 60-day (27% vs. 44%, p=0.0083), and 90-day (28% vs. 46%, p=0.0139). Unadjusted mortality rates were: 30-day (3% vs. 9%, p=0.1377), 60-day (6% vs. 12%, p=0.2020), and 90-day (7% vs. 15%, p=0.1216). In multivariable models, ceftaroline patients were less likely than daptomycin patients to experience hospital readmission at 30 days (OR=0.54, 95%CI=0.29-0.98), 60 days (0.42, 0.23-0.76), and 90 days (0.42, 0.23-0.75); and less likely to experience mortality at 30 days (0.23, 0.04-0.82), 60 days (0.34, 0.10-0.93), and 90 days (0.34, 0.11-0.86).
Conclusion: In this population, ceftaroline was consistently associated with lower hospital readmission and patient mortality for all time points evaluated, as compared to daptomycin, when used as first-line therapy for bacteremia and/or sepsis. Prospective investigations in larger, more generalized cohorts are needed to confirm or refute these findings.
M. L. Mootz,
G. C. Lee, None
K. R. Reveles, Merck: Grant Investigator , Research grant
N. K. Boyd, None
K. E. Evoy, None
C. R. Frei, None
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