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Abstract：
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.
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.
摘要：
背景：Oritavancin，一种被批准用于急性细菌性皮肤和皮肤结构感染的长效脂糖肽，评估在革兰氏阳性微生物引起的严重感染中使用的数据有限。我们旨在评估奥利万星用于革兰氏阳性血流感染（BSI）的巩固治疗的有效性和安全性，包括感染性心内膜炎（IE）。
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月科罗拉多大学医院收治的成年患者，这些患者接受了≥1次奥利万星剂量治疗革兰氏阳性BSI。如果指标培养是在外部设施绘制的或年龄>89岁的患者被排除在外。主要结果是90天随访的患者出现90天复合失败（临床或微生物失败）。次要结局包括主要结局的各个组成部分，急性肾损伤(AKI),输液相关反应（IRR），和制度成本规避。
结果：总体而言，包括72例患者。平均±SD年龄为54±16岁，61%为男性，10%有IE。最常引起BSI的生物是金黄色葡萄球菌(68%，17％耐甲氧西林），其次是链球菌。（26%），和肠球菌属。（10%）。患者在奥利万星之前接受标准护理抗生素的中位数（IQR）为11（5-17）天。90天临床可评估人群（n=64）的复合失败发生率为14％，由临床和微生物失败组成，发生在14%和5%的患者中，分别。三名患者（4％）在oritavancin后出现AKI，两人(3%)经历了内部收益率。Oritavancin的使用导致94％的患者提前出院，相当于节省了1,102个住院天数（平均16天/患者），避免了3,055,804美元（平均44,938美元/患者）的机构费用。
结论：使用奥利万星可能是革兰氏阳性BSI的有效序贯疗法，以促进早期出院，从而避免机构费用。
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月科罗拉多大学医院收治的成年患者，这些患者接受了≥1次奥利万星剂量治疗革兰氏阳性BSI。如果指标培养是在外部设施绘制的或年龄>89岁的患者被排除在外。主要结果是90天随访的患者出现90天复合失败（临床或微生物失败）。次要结局包括主要结局的各个组成部分，急性肾损伤(AKI),输液相关反应（IRR），和制度成本规避。
结果：总体而言，包括72例患者。平均±SD年龄为54±16岁，61%为男性，10%有IE。最常引起BSI的生物是金黄色葡萄球菌(68%，17％耐甲氧西林），其次是链球菌。（26%），和肠球菌属。（10%）。患者在奥利万星之前接受标准护理抗生素的中位数（IQR）为11（5-17）天。90天临床可评估人群（n=64）的复合失败发生率为14％，由临床和微生物失败组成，发生在14%和5%的患者中，分别。三名患者（4％）在oritavancin后出现AKI，两人(3%)经历了内部收益率。Oritavancin的使用导致94％的患者提前出院，相当于节省了1,102个住院天数（平均16天/患者），避免了3,055,804美元（平均44,938美元/患者）的机构费用。
结论：使用奥利万星可能是革兰氏阳性BSI的有效序贯疗法，以促进早期出院，从而避免机构费用。
