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Prospective Evaluation of Clinical and Economic Outcomes Associated With Treatment of Serious Infections Due to Gram-Positive Cocci

Hermsen, Elizabeth D. PharmD, MBA*†‡; Shull, Sara S. PharmD, MBA*; Mitropoulos, Isaac F. PharmD*; Puumala, Susan E. MS§; Rupp, Mark E. MD‡

Infectious Diseases in Clinical Practice:
doi: 10.1097/IPC.0b013e318184d74e
Original Articles
Abstract

Comparative data are needed to define the use of agents to treat serious gram-positive cocci infections. This prospective, open-label, observational cohort study included adults receiving daptomycin, linezolid, vancomycin, or oxacillin/cefazolin for complicated skin and skin structure infections, bacteremia, endocarditis, or osteomyelitis. Primary outcome was clinical response at 180 days. Secondary outcomes included response at the end of therapy, antibiotic switch due to failure, length of stay (LOS), LOS after antibiotic start, mortality, infection-related readmission, and antibiotic and hospitalization costs. One hundred seventeen patients were evaluated for complicated skin and skin structure infections (n= 37), bacteremia (n = 49), endocarditis (n = 10), and osteomyelitis (n = 21). Daptomycin (P = 0.008) and linezolid (P = 0.02) were used more often as second-line therapy. No significant differences were found in outcomes except LOS (P = 0.05), and hospitalization costs (P = 0.004) were higher with linezolid; antibiotic costs were higher for linezolid (P = 0.001) and daptomycin (P = 0.03). Response rates were similar for the study drugs, although daptomycin and linezolid were used as second-line therapy and associated with higher drug costs.

Author Information

From the *Department of Pharmaceutical and Nutrition Care, The Nebraska Medical Center; †Department of Pharmacy Practice, College of Pharmacy, ‡Section of Infectious Diseases, Department of Internal Medicine, College of Medicine, and §Biostatistics Division, College of Public Health, University of Nebraska Medical Center, Omaha, NE.

Reprints: Elizabeth D. Hermsen, PharmD, MBA, Department of Pharmaceutical and Nutrition Care, The Nebraska Medical Center, Omaha, NE 68198-8485. E-mail: ehermsen@nebraskamed.com.

No financial support was received for this study.

Data were presented in part at the 44th Annual Meeting of the Infectious Diseases Society of America, October 12-15, 2006, Toronto, Ontario, Canada.

Dr Hermsen is member of the speakers' bureau, Pfizer, and Dr Rupp is member of the advisory board, speakers' bureau, Cubist. Dr Shull, Dr Mitropoulos, Ms Puumala, and Dr Rupp declare no conflict of interest.

© 2009 Lippincott Williams & Wilkins, Inc.