ISSN: 2640-2653
Authors: Stoneking C, Moenster R* and Lin neman T
Purpose: The purpose of this study was to determine if vancomycin therapy was associated with higher rates of clinical failure compared to those treated with daptomycin or ceftaroline therapy (DCT) in patients receiving outpatient parenteral antimicrobial therapy (OPAT). Methods: This was a retrospective, single center cohort study including patients who received ≥ 7 days of OPAT with vancomycin, ceftaroline, or daptomycin from 01/01/2009 through 03/31/2016 at the VA Saint Louis Healthcare System. The primary outcome was clinical failure, defined as a composite of acute kidney injury (AKI), creatinine phosphokinase elevations ≥ 500 units/L, adverse drug events necessitating a change in therapy, readmission due to recurrence of infection, or reinitiation of antibiotics after discontinuation. Multivariate logistic regression was used to evaluate independent risk factors for clinical failure. Results: A total of 125 patients were included in the analysis – 72 receiving vancomycin and 53 receiving DCT. Baseline characteristics between groups were similar, except patients in the DCT group had a greater mean serum creatinine and a higher rate of CKD at baseline; 1.53 vs 1.23 (p=0.032) and 35.9% vs. 19.4% (p=0.04) respectively. Forty three percent (31/72) of patients receiving vancomycin developed clinical failure compared to 54.7% (29/53) of DCT patients (p=0.197). Of the secondary outcomes analyzed, only readmission due to recurrence was significant between groups (vancomycin vs. DCT) – 13.8% vs. 30.2% (p=0.026). None of the factors included in the regression analyses were found to be significant. Conclusions: Vancomycin was not associated with an increased risk of clinical failure when compared to DCT in patients receiving OPAT.
Keywords: Anti-Infective Agents; Home Infusion Therapy; Methicillin-Resistant Staphylococcus Aureus; Outpatient Parenteral Antimicrobial Therapy
