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Telavancin hospital-acquired pneumonia trials: impact of Gram-negative infections and inadequate Gram-negative coverage on clinical efficacy and all-cause mortality.

Publication ,  Journal Article
Lacy, MK; Stryjewski, ME; Wang, W; Hardin, TC; Nogid, B; Luke, DR; Shorr, AF; Corey, GR; Barriere, SL
Published in: Clin Infect Dis
September 15, 2015

BACKGROUND: When hospital-acquired or ventilator-associated bacterial pneumonia (HABP/VABP) is caused by gram-positive and gram-negative pathogens or both (mixed infections), the adequacy of gram-negative coverage (GNC) can confound the assessment of a gram-positive agent under study. This analysis examines the influence of gram-negative infections and the adequacy of GNC on clinical efficacy and all-cause mortality in the telavancin HABP/VABP phase 3 ATTAIN trials (Assessment of Telavancin for Treatment of Hospital-Acquired Pneumonia). METHODS: This post hoc analysis evaluated 3 patient groups from ATTAIN: (1) gram-positive-only infections, (2) gram-positive-only and mixed infections-adequate GNC, and (3) gram-negative-only infections and mixed infections with inadequate GNC. For each, clinical efficacy at test of cure and all-cause mortality at day 28 were compared for telavancin and vancomycin. RESULTS/CONCLUSIONS: In the ATTAIN safety population there were 16 more deaths in the telavancin arms than in the vancomycin arms. Of these, 13 were in patients with gram-negative-only infections (n = 9) or with mixed infections and inadequate GNC (n = 4) and all had estimated baseline creatinine clearances of <30ml/min. Based on this analysis, clinical response and all-cause mortality could be confounded because there were more patients with gram-negative pathogens at baseline and more patients received inadequate treatment of these gram-negative infections in the telavancin groups.

Duke Scholars

Published In

Clin Infect Dis

DOI

EISSN

1537-6591

Publication Date

September 15, 2015

Volume

61 Suppl 2

Start / End Page

S87 / S93

Location

United States

Related Subject Headings

  • Young Adult
  • Vancomycin
  • Treatment Outcome
  • Time Factors
  • Pneumonia, Ventilator-Associated
  • Middle Aged
  • Microbiology
  • Male
  • Lipoglycopeptides
  • Humans
 

Citation

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Lacy, M. K., Stryjewski, M. E., Wang, W., Hardin, T. C., Nogid, B., Luke, D. R., … Barriere, S. L. (2015). Telavancin hospital-acquired pneumonia trials: impact of Gram-negative infections and inadequate Gram-negative coverage on clinical efficacy and all-cause mortality. Clin Infect Dis, 61 Suppl 2, S87–S93. https://doi.org/10.1093/cid/civ536
Lacy, Melinda K., Martin E. Stryjewski, Whedy Wang, Thomas C. Hardin, Boris Nogid, David R. Luke, Andrew F. Shorr, G Ralph Corey, and Steven L. Barriere. “Telavancin hospital-acquired pneumonia trials: impact of Gram-negative infections and inadequate Gram-negative coverage on clinical efficacy and all-cause mortality.Clin Infect Dis 61 Suppl 2 (September 15, 2015): S87–93. https://doi.org/10.1093/cid/civ536.
Lacy MK, Stryjewski ME, Wang W, Hardin TC, Nogid B, Luke DR, et al. Telavancin hospital-acquired pneumonia trials: impact of Gram-negative infections and inadequate Gram-negative coverage on clinical efficacy and all-cause mortality. Clin Infect Dis. 2015 Sep 15;61 Suppl 2:S87–93.
Lacy, Melinda K., et al. “Telavancin hospital-acquired pneumonia trials: impact of Gram-negative infections and inadequate Gram-negative coverage on clinical efficacy and all-cause mortality.Clin Infect Dis, vol. 61 Suppl 2, Sept. 2015, pp. S87–93. Pubmed, doi:10.1093/cid/civ536.
Lacy MK, Stryjewski ME, Wang W, Hardin TC, Nogid B, Luke DR, Shorr AF, Corey GR, Barriere SL. Telavancin hospital-acquired pneumonia trials: impact of Gram-negative infections and inadequate Gram-negative coverage on clinical efficacy and all-cause mortality. Clin Infect Dis. 2015 Sep 15;61 Suppl 2:S87–S93.
Journal cover image

Published In

Clin Infect Dis

DOI

EISSN

1537-6591

Publication Date

September 15, 2015

Volume

61 Suppl 2

Start / End Page

S87 / S93

Location

United States

Related Subject Headings

  • Young Adult
  • Vancomycin
  • Treatment Outcome
  • Time Factors
  • Pneumonia, Ventilator-Associated
  • Middle Aged
  • Microbiology
  • Male
  • Lipoglycopeptides
  • Humans