The Real-World Economic and Clinical Management of Adult Patients with Skin and Soft Tissue Infections (SSTIs) with Oritavancin: Data from Two Multicenter Observational Cohort Studies

Abstract

Background Oritavancin is a FDA-approved single-dose IV therapy for the treatment of acute bacterial skin and skin structure infections caused (or suspected to be caused) by certain Gram-positive pathogens, including methicillin-resistant Staphylococcus aureus (MRSA). Published data describing the outcomes of patients with skin and soft tissue infections (SSTIs) who received oritavancin beyond its pivotal phase III clinical trials are scant. Objective The purpose of this report was to describe the results of two separate multicenter observational cohort studies that described the outcomes associated with two unique real-world usage patterns of oritavancin. Methods The first cohort (n = 115) examined patients 18 years or older who were treated with oritavancin at three outpatient sites for SSTIs caused by suspected or confirmed Gram-positive pathogens, including MRSA, to avoid hospital admission. Patients were included if they had not been discharged from the inpatient setting within the previous 24 h and received their single-dose oritavancin treatment at a hospital-based outpatient infusion center. The primary outcomes measured were 30-day healthcare costs and admissions (all cause and infection related). The second cohort (n = 151) was a multicenter, retrospective chart review of adult patients who were discharged early from seven hospitals in 2015 on oritavancin for SSTIs. The primary outcome was readmission of patients within 30 days (all cause and infection related). Results In cohort 1, 30-day mean healthcare costs were USD 3698. In the study of patients who started oritavancin in the outpatient setting, 7 patients (6.1%) were admitted to hospital within 30 days of the index treatment, and 3 of those (2.6% overall) were deemed to be due to an infection. In cohort 2, all-cause and infection-related 30-day readmission rates were 6.6% and 2.6%, respectively, among patients who received oritavancin at hospital discharge. Conclusions Findings from these studies suggest that oritavancin may be a potentially useful agent to avoid hospitalization or shorten hospital length of stay among appropriate SSTI patients. Future comparator studies are required to properly ascertain the outcomes and potential benefits associated with oritavancin relative to other commonly used antibiotics in patients with SSTIs.

Early Directed Oritavancin Therapy in the Emergency Department May Lead to Hospital Avoidance Compared to Standard Treatment for Acute Bacterial Skin and Skin Structure Infections: A Real-World Retrospective Analysis

“…In an assessment of 67 patients who received oritavancin at a community hospital, no readmissions and 8 ED return visits were observed within 14 days of discharge [18]. Similarly, the 30-day subsequent readmission rate was reported to be 6.1% in an evaluation of oritavancin for ABSSSI patients across three hospital-based outpatient infusion centers [19]. In our study, the observed 30-day readmission rate was slightly higher (9.8%), but this may have been due to the aggressive mandated pharmacy callback system, which encouraged patients to return to the hospital if symptoms were not completely resolved.…”

Expediting Discharge in Hospitalized, Adult Patients with Skin and Soft Tissue Infections Who Received Empiric Vancomycin Therapy with Oritavancin: Description of Findings from an Institutional Pathway

“…The low 30-day readmission and infection progression rates observed among patients who received oritavancin are consistent with other studies of an identical nature. In a multicenter, retrospective study that evaluated the use of oritavancin upon hospital discharge to complete treatment of an SSTI, infection-related 30-day readmission rates were 2.6% [16]. Similarly, no patients had to be readmitted within 14 days of oritavancin therapy in an evaluation of oritavancin use at a community hospital to facilitate hospital discharge [17].…”

Amplify antimicrobial photo dynamic therapy efficacy with poly-beta-amino esters (PBAEs)

“…Antibiotics are the first line approach to treat SSTI, however their efficacy is rapidly decreasing in consequence of the growth of antibiotic resistance among pathogens. New antibiotics, such as oritavancin or delafloxacin, to treat SSTI, have emerged 7 , 8 ; nonetheless it is expected that antibiotic resistance will outpace the development of new drug thus different antimicrobial treatment is urgently needed.…”