Telavancin as an Alternative Treatment for Gram-Positive Bloodstream Infections in Patients with Cancer: A Case Control Study.
Antimicrob Agents Chemother. 2015 Oct 19;
Authors: Chaftari AM, Hachem R, Jordan M, Garoge K, Al Hamal Z, El Zakhem A, Viola GM, Granwehr B, Mulanovich V, Gagel A, Reitzel R, Yousif A, Jiang Y, Raad I
Gram-positive bacteria infections are an important cause of morbidity and mortality in cancer patients despite current therapy. In this case control study, we evaluated the clinical outcomes and safety of telavancin in cancer patients with uncomplicated gram-positive BSIs. Between March 2011 and May 2013, we enrolled cancer patients with uncomplicated gram-positive bloodstream infections (BSIs) to receive intravenous telavancin for at least 14 days for Staphylococcus aureus and 7 days for other gram-positive cocci. Patients with baseline creatinine clearance (Cr Cl) >50mL/min received 10mg/kg/day of telavancin, and those with Cr Cl between 30-49mL/min received 7.5mg/kg/day. Patients were compared with a retrospective cohort of 39 historical patients matched for underlying malignancy, infecting organism, and neutropenia status with gram-positive BSIs who were treated with vancomycin. A total of 78 patients were analyzed, 39 in each group. The most common pathogen causing BSI was S. aureus (51%), followed by alpha-hemolytic Streptococci (23%), Enterococci spp.(15%), coagulase-negative Staphylococci (8%), and beta-hemolytic Streptococci (3%). Sixty-two percent of patients had hematological malignancies, and 38% had solid tumors. 51% of patients were neutropenic. Overall response determined by clinical outcome and microbiological eradication at 72 hours following initiation of therapy, in the absence of relapse, deep-seated infections and infection-related mortality was better with telavancin compared to vancomycin (86% vs. 61%; P=0.013). Drug-related adverse events were similar in both groups (telavancin, 31% vs vancomycin, 23%; P = .79), with similar incidences of renal adverse events. Telavancin may provide a useful alternative to standard vancomycin therapy for gram-positive BSI in cancer patients.
PMID: 26482312 [PubMed - as supplied by publisher]