Methods: Retrospective review of pts receiving >24 hour of TED between 6/2015 and 4/2018. Adverse events were determined according to standard definitions.
Results: 55 pts receiving 60 different TED treatment courses were included. The median duration of treatment was 7 days (range: 2 – 141 days); 42% and 16% of pts received courses ≥10 and ≥30 days, respectively. 44% of pts were male, the median age was 58 (20 – 88), and 35% were immunosuppressed, including 22% of pts who received a solid-organ transplant. Indications for TED were skin/soft tissue infections (n=23), bacteremia (n=10), osteomyelitis/septic arthritis (n=7), endocarditis/endovascular infection (n=5), pneumonia (n=4), M. abscessus treatment (n=3), intra-abdominal infection (n=2) and urinary tract infection (n=1). 60% of pts failed alternative therapies prior to TED treatment. Specifically, 31% of pts had documented adverse events to linezolid (n=8), daptomycin (n=3), vancomycin (n=3), quinupristin/dalfopristin, televancin, or tigecycline (n=1 each). At initiation of TED, the median platelet (PLT) count (per 1000 cells/L) was 205 (range: 16 – 674); 20% had baseline thrombocytopenia (PLT <100). Overall, 11% of patients experienced an adverse event or intolerability leading to TED discontinuation, including 3 patients with thrombocytopenia (>50% decrease in PLT) and 1 pt each with a rash, vomiting, and confusion. 67% of pts with thrombocytopenia were previously intolerant of linezolid. No patients experienced lactic acidosis, peripheral neuropathy, or neutropenia. Notably, TED was well tolerated for treatment courses up to 141 days and among 2 patients with repeated, prolonged courses.
Conclusion: Among acutely and chronically-ill patients, TED was well-tolerated. This includes pts who received long-term treatment with TED, and those who were intolerant of alternative antibiotics.
R. V. Marini,
R. K. Shields, Allergan: Grant Investigator , Research grant . Pfizer: Consultant and Scientific Advisor , Speaker honorarium . Shionogi: Scientific Advisor , Consulting fee . Roche: Grant Investigator , Research grant . Venatorx: Grant Investigator , Research grant . Medicines Company: Grant Investigator and Scientific Advisor , Consulting fee and Research grant . Accelerate Diagnostics: Scientific Advisor , Consulting fee .