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A retrospective analysis of adverse events among patients receiving daptomycin versus vancomycin during outpatient parenteral antimicrobial therapy

  • Gregory M. Schrank (a1) (a2), Sharon B. Wright (a1) (a2), Westyn Branch-Elliman (a3) (a2) and Mary T. LaSalvia (a1) (a2)

Abstract

Objective

Outpatient parenteral antimicrobial therapy (OPAT) is a safe and effective alternative to prolonged inpatient stays for patients requiring long-term intravenous antimicrobials, but antimicrobial-associated adverse events remain a significant challenge. Thus, we sought to measure the association between choice of antimicrobial agent (vancomycin vs daptomycin) and incidence of adverse drug events (ADEs).

Methods

Patients receiving OPAT treatment with vancomycin or daptomycin for skin and soft-tissue infections, bone and joint infections, endocarditis, and bacteremia or endovascular infections during the period from July 1, 2013, through September 30, 2016, were included. Demographic and clinical data were abstracted from the medical record. Logistic regression was used to compare ADEs requiring a change in or early discontinuation of therapy, hospital readmission, and emergency room visits between groups. Time from OPAT enrollment to ADE was compared using the log-rank test.

Results

In total, 417 patients were included: 312 (74·8%) received vancomycin and 105 (25·2%) received daptomycin. After adjusting for age, Charlson comorbidity index, location of OPAT treatment, receipt of combination therapy with either β-lactam or fluoroquinolone, renal function, and availability of safety labs, patients receiving vancomycin had significantly higher incidence of ADEs (adjusted odds ratio [aOR], 3·71; 95% CI, 1·64–8·40). ADEs occurred later in the treatment course for patients treated with daptomycin (P<·01). Rates of readmission and emergency room visits were similar.

Conclusions

In the OPAT setting, vancomycin use was associated with higher incidence of ADEs than daptomycin use. This finding is an important policy consideration for programs aiming to optimize outcomes and minimize cost. Careful selection of gram-positive agents for prolonged treatment is necessary to limit toxicity.

Copyright

Corresponding author

Author for correspondence: Gregory Schrank, MD, Beth Israel Deaconess Medical Center, 330 Brookline Ave, SL-431, Boston, MA, 02215. E-mail: gschrank@bidmc.harvard.edu

References

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1. Ruh, CA, Parameswaran, GI, Wojciechowski, AL, Mergenhagen, KA. Outcomes and pharmacoeconomic analysis of a home intravenous antibiotic infusion program in veterans. Clin Therapeut 2015;37:25272535.
2. Durojaiye, OC, Bell, H, Andrews, D, Ntziora, F, Cartwright, K. Clinical efficacy, cost analysis and patient acceptability of outpatient parenteral antibiotic therapy (OPAT): a decade of sheffield (UK) OPAT service. Int J Antimicrob Agents 2018;51:2632.
3. Chapman, AL, Dixon, S, Andrews, D, Lillie, PJ, Bazaz, R, Patchett, JD. Clinical efficacy and cost-effectiveness of outpatient parenteral antibiotic therapy (OPAT): a UK perspective. J Antimicrob Chemother 2009;64:13161324.
4. Saillen, L, Arensdorff, L, Moulin, E, et al. Patient satisfaction in an outpatient parenteral antimicrobial therapy (OPAT) unit practising predominantly self-administration of antibiotics with elastomeric pumps. Eur J Clin Microbiol Infect Dis 2017;36:13871392.
5. Bhavan, KP, Brown, LS, Haley, RW. Self-administered outpatient antimicrobial infusion by uninsured patients discharged from a safety-net hospital: a propensity-score-balanced retrospective cohort study. PLoS Med 2015;12:e1001922.
6. Vargas-Palacios, A, Meads, DM, Twiddy, M, et al. Cost-effectiveness of outpatient parenteral antibiotic therapy: a simulation modelling approach. J Antimicrob Chemother 2017;72:23922400.
7. Suleyman, G, Kenney, R, Zervos, MJ, Weinmann, A. Safety and efficacy of outpatient parenteral antibiotic therapy in an academic infectious disease clinic. J Clin Pharm Therapeut 2017;42:3943.
8. Keller, SC, Williams, D, Gavgani, M, Hirsch, D, Adamovich, J, Hohl, D, Gurses, AP, Cosgrove, SE. Rates of and risk factors for adverse drug events in outpatient parenteral antimicrobial therapy. Clin Infect Dis 2018;66:1119.
9. Lee, B, Tam, I, Weigel, Bt, et al. Comparative outcomes of beta-lactam antibiotics in outpatient parenteral antibiotic therapy: treatment success, readmissions and antibiotic switches. J Antimicrob Chemother 2015;70:23892396.
10. Means, L, Bleasdale, S, Sikka, M, Gross, AE. Predictors of hospital readmission in patients receiving outpatient parenteral antimicrobial therapy. Pharmacotherapy 2016;36:934939.
11. Hale, CM, Steele, JM, Seabury, RW, Miller, CD. Characterization of drug-related problems occurring in patients receiving outpatient antimicrobial therapy. J Pharm Pract 2017;30:600605.
12. Shrestha, NK, Mason, P, Gordon, SM, et al. Adverse events, healthcare interventions and healthcare utilization during home infusion therapy with daptomycin and vancomycin: a propensity score-matched cohort study. J Antimicrob Chemother 2014;69:14071415.
13. Shrestha, NK, Shrestha, J, Everett, A, et al. Vascular access complications during outpatient parenteral antimicrobial therapy at home: a retrospective cohort study. J Antimicrob Chemother 2016;71:506512.
14. Schmidt, M, Hearn, B, Gabriel, M, Spencer, MD, McCurdy, L. Predictors of unplanned hospitalization in patients receiving outpatient parenteral antimicrobial therapy across a large integrated healthcare network. Open Forum Infect Dis 2017;4:ofx086.
15. Allison, GM, Muldoon, EG, Kent, DM, et al. Prediction model for 30-day hospital readmissions among patients discharged receiving outpatient parenteral antibiotic therapy. Clin Infect Dis 2014;58:812819.
16. Tice, AD, Rehm, SJ, Dalovisio, JR, et al. Practice guidelines for outpatient parenteral antimicrobial therapy. IDSA guidelines. Clin Infect Dis 2004;38:16511672.
17. Conant, MM, Erdman, SM, Osterholzer, D. Mandatory infectious diseases approval of outpatient parenteral antimicrobial therapy (OPAT): clinical and economic outcomes of averted cases. J Antimicrob Chemother 2014;69:16951700.
18. Gilchrist, M, Seaton, RA. Outpatient parenteral antimicrobial therapy and antimicrobial stewardship: challenges and checklists. J Antimicrob Chemother 2015;70:965970.
19. Muldoon, EG, Snydman, DR, Penland, EC, Allison, GM. Are we ready for an outpatient parenteral antimicrobial therapy bundle? A critical appraisal of the evidence. Clin Infect Dis 2013;57:419424.
20. Madaline, T, Nori, P, Mowrey, W, et al. Bundle in the Bronx: impact of a transition-of-care outpatient parenteral antibiotic therapy bundle on all-cause 30-day hospital readmissions. Open Forum Infect Dis 2017;4:ofx097.
21. Tamma, PD, Avdic, E, Li, DX, Dzintars, K, Cosgrove, SE. Association of adverse events with antibiotic use in hospitalized patients. JAMA Intern Med 2017;177:13081315.
22. Branch-Elliman, W, Ripollone, JE, O’Brien, WJ, et al. Risk of surgical site infection, acute kidney injury, and Clostridium difficile infection following antibiotic prophylaxis with vancomycin plus a beta-lactam versus either drug alone: a national propensity-score-adjusted retrospective cohort study. PLoS Med 2017;14:e1002340.
23. Karino, S, Kaye, KS, Navalkele, B, et al. Epidemiology of acute kidney injury among patients receiving concomitant vancomycin and piperacillin-tazobactam: opportunities for antimicrobial stewardship. Antimicrob Agent Chemother 2016;60:37433750.
24. Kim, T, Kandiah, S, Patel, M, et al. Risk factors for kidney injury during vancomycin and piperacillin/tazobactam administration, including increased odds of injury with combination therapy. BMC Res Note 2015;8:579.
25. Moenster, RP, Linneman, TW, Finnegan, PM, Hand, S, Thomas, Z, McDonald, JR. Acute renal failure associated with vancomycin and beta-lactams for the treatment of osteomyelitis in diabetics: piperacillin-tazobactam as compared with cefepime. Clin Microbiol Infect 2014;20:O384O389.
26. Quan, H, Sundararajan, V, Halfon, P, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Medical Care 2005;43:11301139.
27. Li, B, Evans, D, Faris, P, Dean, S, Quan, H. Risk adjustment performance of Charlson and Elixhauser comorbidities in ICD-9 and ICD-10 administrative databases. BMC Health Serv Res 2008;8:12.
28. Huck, D, Ginsberg, JP, Gordon, SM, Nowacki, AS, Rehm, SJ, Shrestha, NK. Association of laboratory test result availability and rehospitalizations in an outpatient parenteral antimicrobial therapy programme. J Antimicrob Chemother 2014;69:228233.
29. Acuna-Villaorduna, C, Branch-Elliman, W, Strymish, J, Gupta, K. Active identification of patients who are methicillin-resistant Staphylococcus aureus colonized is not associated with longer duration of vancomycin therapy. Am J Infect Control 2017;45:10811085.
30. Keller, SC, Ciuffetelli, D, Bilker, W, et al. The impact of an infectious diseases transition service on the care of outpatients on parenteral antimicrobial therapy. J Pharm Technol 2013;29:205214.
31. Lane, MA, Marschall, J, Beekmann, SE, et al. Outpatient parenteral antimicrobial therapy practices among adult infectious disease physicians. Infect Control Hosp Epidemiol 2014;35:839844.

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A retrospective analysis of adverse events among patients receiving daptomycin versus vancomycin during outpatient parenteral antimicrobial therapy

  • Gregory M. Schrank (a1) (a2), Sharon B. Wright (a1) (a2), Westyn Branch-Elliman (a3) (a2) and Mary T. LaSalvia (a1) (a2)

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