Shrestha Nabin K, Mason Pamela, Gordon Steven M, Neuner Elizabeth, Nutter Benjamin, O'Rourke Colin, Rehm Susan J
Department of Infectious Disease, Cleveland Clinic, Cleveland, OH 44195, USA.
J Antimicrob Chemother. 2014 May;69(5):1407-15. doi: 10.1093/jac/dkt512. Epub 2014 Jan 6.
Vancomycin and daptomycin are the two most frequently prescribed parenteral antimicrobials for resistant Gram-positive bacterial infections. The purpose of this study was to compare antimicrobial adverse event rates and associated healthcare interventions and healthcare utilization in patients treated with the two antimicrobials.
All patients aged ≥18 years, discharged home from Cleveland Clinic on outpatient parenteral antimicrobial therapy (OPAT) with daptomycin or vancomycin between 1 July 2007 and 30 June 2010 were screened. Logistic regression models were built to calculate propensity to be treated with daptomycin for each patient. Propensity score-matched vancomycin-treated controls were identified for each daptomycin-treated patient. Adverse event, healthcare intervention and healthcare utilization rates during OPAT were compared in the matched cohort using negative binomial regression models.
One thousand, two hundred and eighty-eight patients were identified. Three-to-one matching provided the best matching characteristics and identified 119 daptomycin-treated subjects (2518 OPAT days) and 357 vancomycin-treated controls (6649 OPAT days). The mean patient age was 56 years and the mean OPAT duration was 19 days. Antimicrobial adverse event rates for the daptomycin and vancomycin groups were 3.2 and 7.7 per 1000 OPAT days, respectively [relative risk (RR) 0.38; 95% CI 0.15-0.86; P = 0.02]. Antimicrobial intervention rates were 5.6 and 27.1 per 1000 OPAT days, respectively (RR 0.21; 95% CI 0.11-0.36; P < 0.001). Readmissions for worsening infection or treatment complication were not significantly different between daptomycin (5%) and vancomycin (7%).
Patients receiving daptomycin at home have 60% fewer antimicrobial adverse events and require 80% fewer antimicrobial interventions than similar patients receiving vancomycin.
万古霉素和达托霉素是治疗耐药革兰氏阳性菌感染最常用的两种胃肠外抗菌药物。本研究旨在比较接受这两种抗菌药物治疗的患者的抗菌药物不良事件发生率以及相关的医疗干预措施和医疗资源利用情况。
对2007年7月1日至2010年6月30日期间从克利夫兰诊所出院并接受门诊胃肠外抗菌治疗（OPAT）、使用达托霉素或万古霉素的所有年龄≥18岁的患者进行筛查。建立逻辑回归模型，计算每位患者接受达托霉素治疗的倾向。为每位接受达托霉素治疗的患者确定倾向评分匹配的万古霉素治疗对照组。使用负二项回归模型比较匹配队列中OPAT期间的不良事件、医疗干预和医疗资源利用率。
共识别出1288例患者。三比一匹配提供了最佳匹配特征，识别出119例接受达托霉素治疗的受试者（2518个OPAT日）和357例接受万古霉素治疗的对照组（6649个OPAT日）。患者平均年龄为56岁，平均OPAT持续时间为19天。达托霉素组和万古霉素组的抗菌药物不良事件发生率分别为每1000个OPAT日3.2例和7.7例[相对风险（RR）0.38；95%置信区间0.15 - 0.86；P = 0.02]。抗菌药物干预率分别为每1000个OPAT日5.6例和27.1例（RR 0.21；95%置信区间0.11 - 0.36；P < 0.001）。达托霉素组（5%）和万古霉素组（7%）因感染恶化或治疗并发症再次入院的情况无显著差异。
与接受万古霉素治疗的类似患者相比，在家接受达托霉素治疗的患者抗菌药物不良事件减少60%，抗菌药物干预需求减少80%。
