奥他万古霉素作为革兰阳性菌血流感染的序贯治疗药物。
Oritavancin as sequential therapy for Gram-positive bloodstream infections.
机构信息
Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Science, Aurora, CO, USA.
Department of Pharmacy-Infectious Diseases, University of Colorado Hospital, Aurora, CO, USA.
出版信息
BMC Infect Dis. 2024 Jan 24;24(1):127. doi: 10.1186/s12879-023-08725-8.
BACKGROUND
Oritavancin, a long-acting lipoglycopeptide approved for use in acute bacterial skin and skin structure infections, has limited data evaluating use in serious infections due to Gram-positive organisms. We aimed to assess the effectiveness and safety of oritavancin for consolidative treatment of Gram-positive bloodstream infections (BSI), including infective endocarditis (IE).
METHODS
We conducted a retrospective cohort study evaluating adult patients admitted to University of Colorado Hospital from March 2016 to January 2022 who received ≥ 1 oritavancin dose for treatment of Gram-positive BSI. Patients were excluded if the index culture was drawn at an outside facility or were > 89 years of age. The primary outcome was a 90-day composite failure (clinical or microbiological failure) in those with 90-day follow-up. Secondary outcomes included individual components of the primary outcome, acute kidney injury (AKI), infusion-related reactions (IRR), and institutional cost avoidance.
RESULTS
Overall, 72 patients were included. Mean ± SD age was 54 ± 16 years, 61% were male, and 10% had IE. Organisms most commonly causing BSI were Staphylococcus aureus (68%, 17% methicillin-resistant), followed by Streptococcus spp. (26%), and Enterococcus spp. (10%). Patients received standard-of-care antibiotics before oritavancin for a median (IQR) of 11 (5-17) days. Composite failure in the clinically evaluable population (n = 64) at 90-days occurred in 14% and was composed of clinical and microbiological failure, which occurred in 14% and 5% of patients, respectively. Three patients (4%) experienced AKI after oritavancin, and two (3%) experienced an IRR. Oritavancin utilization resulted in earlier discharge for 94% of patients corresponding to an institutional cost-avoidance of $3,055,804 (mean $44,938/patient) from 1,102 hospital days saved (mean 16 days/patient).
CONCLUSIONS
The use of oritavancin may be an effective sequential therapy for Gram-positive BSI to facilitate early discharge resulting in institutional cost avoidance.
背景
奥利万星是一种长效糖肽类抗生素，已被批准用于治疗急性细菌性皮肤和皮肤结构感染，关于其在由革兰阳性菌引起的严重感染中的应用，仅有有限的数据。我们旨在评估奥利万星用于巩固治疗革兰阳性菌血流感染（BSI），包括感染性心内膜炎（IE）的有效性和安全性。
方法
我们进行了一项回顾性队列研究，评估了 2016 年 3 月至 2022 年 1 月期间在科罗拉多大学医院住院的接受至少 1 剂奥利万星治疗革兰阳性菌 BSI 的成年患者。如果索引培养是在外部机构获得的或患者年龄>89 岁，则将患者排除在外。主要结局是在有 90 天随访的患者中，90 天复合失败（临床或微生物学失败）。次要结局包括主要结局的各个组成部分、急性肾损伤（AKI）、输注相关反应（IRR）和机构成本避免。
结果
共有 72 例患者被纳入研究。平均年龄±标准差为 54±16 岁，61%为男性，10%患有 IE。引起 BSI 的最常见病原体是金黄色葡萄球菌（68%，17%为耐甲氧西林金黄色葡萄球菌），其次是链球菌属（26%）和肠球菌属（10%）。在接受奥利万星治疗之前，患者接受了标准治疗抗生素，中位（IQR）时间为 11（5-17）天。在可临床评估人群（n=64）中，90 天复合失败的发生率为 14%，由临床和微生物学失败组成，分别有 14%和 5%的患者发生。3 例（4%）患者在使用奥利万星后出现 AKI，2 例（3%）患者出现 IRR。奥利万星的使用使 94%的患者提前出院，从而使医院节省了 1102 个住院日，即平均每位患者节省 16 天，避免了 3055804 美元的机构成本（平均每位患者 44938 美元）。
结论
奥利万星的使用可能是治疗革兰阳性菌 BSI 的一种有效的序贯治疗方法，可促进提前出院，从而节省机构成本。
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