Category: Professional Posters
Purpose: Oritavancin is a lipoglycopeptide with in vitro bactericidal activity against gram-positive pathogens that is indicated for use in acute bacterial skin and skin structure infections (ABSSSI). Its concentration-dependent activity in vitro and prolonged half-life provide a convenient single-dose alternative to multi-dose therapies for ABSSSI. This retrospective cohort study was conducted to quantify the clinical and economic advantages of using oritavancin compared to other antibiotic agents that have been historically effective for ABSSSI.
Methods: Ninety patients were treated between 2015 and 2018 with a single dose of oritavancin 1200 milligrams infused over 3 hours and included in cohort A. All patients in cohort A failed a recent course of other antibiotics (OAT). These patients were matched with a randomly selected cohort of 91 patients admitted during the same period for failure of recent therapy or first-time treatment for ABSSSI. Demographic data and clinical outcomes were obtained by chart abstraction. Economic data was provided by medical records. Failure of a recent course of OAT was defined as patients who had taken at least one dose of a prescribed antibiotic regimen and presented or returned to the hospital within 14 days due to worsening infection symptoms or lack of improvement. Patients were excluded from the study for any of the following: osteomyelitis, endocarditis, primary or secondary bacteremia, age < 18 years, length of inpatient stay exceeding 7 days, any ICU stay during hospital admission, and infections that required major surgical debridement and/or wound care. The primary clinical endpoint was defined as average length of stay (aLOS). The secondary endpoints included readmission rates for the same indication at 30 and 90 days after discharge and the average hospital charge (aHC).
Results: A total of 181 patients were admitted to the medical service mainly for treatment of recurrent ABSSSI with oritavancin, or recurrent or first episode of ABSSSI treated with comparator agents. Demographic characteristics of both the oritavancin and comparator groups were similar. Cellulitis was the predominant infection (83% and 69% for cohorts A and B, respectively). Clinical failure of first-line antibiotic choices was 100% by definition and these patients received oritavancin per protocol. Only 7 of 90 (7.8%) patients failed therapy with oritavancin therapy. The primary clinical endpoint showed significant decrease in aLOS between oritavancin group versus comparator (2.3 days versus 3.1 days; p<0.05, CI 95%, -1.2 to -0.4) despite factors suggesting the oritavancin cohort exhibited a higher frequency of complicated infections and recurrent infection. The secondary endpoints were significant for lower readmission rates associated with oritavancin treatment at 30 and 90 days. All-cause readmission within 30 and 90 days for oritavancin was 11% and 13%, respectively, while for the comparator group was 31% for both timepoints (p=0.0012 and p=0.0047 for both timepoints). The average hospital charge was 24% lower for patients that received oritavancin.
Conclusion: The results of this study demonstrate that oritavancin provides not only a single-dose alternative to multi-dose therapies for ABSSSI, but also a clinical and economic advantage compared to other antibiotic agents.