Work

Comparative-Effectiveness of Ceftaroline and Daptomycin as First-Line Therapy for Patients With Bacteremia or Sepsis Admitted to Hospitals in the United States Veterans Health Care System

Year: 2016

Type: article

Abstract: Background. Bacteremia and sepsis infections are on the rise, and evidence to support specific drugs for treatment is lacking. This study compared hospital readmission and mortality for patients who received first-line ceftaroline or daptomycin for bacteremia and/or sepsis. Methods. This was a retrospective, cohort, comparative-effectiveness study of adults (age 18+ years), admitted to hospitals in the United States Veterans Health Care System, with bacteremia and/or sepsis (by ICD9 codes), between 1 October 2010 and 30 September 2014, and who received ceftaroline or daptomycin as first-line therapy within 14 days of admission. Patients who received both study drugs were excluded. Chi-square, Fisher's exact, and Wilcoxon rank-sum tests were used to compare baseline characteristics. Multivariable logistic regression models were used to compare patient outcomes. Model covariates were those factors with p < 0.05 in bivariable analysis. Results. A total of 409 patients were included (ceftaroline = 67 and daptomycin = 342). Ceftaroline patients were older, more likely to be Black, had higher Charlson comorbidity scores, and were more likely to have a history of diabetes with complications. Median (25th–75th percentile) time from hospital admission to study drug initiation was 1 (0–1) day for ceftaroline and 1 (1–3) day for daptomycin. Unadjusted hospital readmission rates for ceftaroline versus daptomycin were as follows: 30-day (25% versus 37%, p = 0.0597), 60-day (27% versus 44%, p = 0.0083), and 90-day (28% versus 46%, p = 0.0139). Unadjusted mortality rates were as follows: 30-day (3% versus 9%, p = 0.1377), 60-day (6% versus 12%, p = 0.2020), and 90-day (7% versus 15%, p = 0.1216). In multivariable models, ceftaroline patients were less likely than daptomycin patients to experience hospital readmission at 30 days (OR = 0.54, 95% CI = 0.29–0.98), 60 days (0.42, 0.23–0.76), and 90 days (0.42, 0.23–0.75); and less likely to experience mortality at 30 days (0.23, 0.04–0.82), 60 days (0.34, 0.10–0.93), and 90 days (0.34, 0.11–0.86). Conclusion. In this population, ceftaroline was consistently associated with lower hospital readmission and patient mortality for all time points evaluated, as compared to daptomycin, when used as first-line therapy for bacteremia and/or sepsis. Prospective investigations in larger, more generalized cohorts are needed to confirm or refute these findings. Disclosures. K. R. Reveles, Merck: Grant Investigator, Research grant

Source: Open Forum Infectious Diseases

DOI: 10.1093/ofid/ofw172.748