A Retrospective Case Series of Telavancin for the Treatment of Staphylococcus aureus Bacteremia
Authors: Saravolatz Louis D. , Cleveland Kerry O. , Rikabi Khalid , Hassoun Ali , Reilly Joseph , Johnson Leonard B. , Spak Cedric , Valenti Sharon , Szpunar Susan 
Published: April 2018

Purpose
Telavancin (TLV) is approved for complicated skin and skin structure infections and hospital-acquired pneumonia. This report represents a retrospective analysis of patients with Staphylococcus aureus bacteremia who, at the physician's discretion, received TLV at some time during their course.

Methods
The primary outcome measure was the percent of patients cured or improved at the end of TLV therapy (EOTT). The secondary outcome was the percent of patients cured or improved at least 30 days after discontinuation of TLV therapy.

Results
There were 46 cases of S. aureus bacteremia, with 44 (95.7%) being methicillin-resistant S. aureus and 2 (4.3%) methicillin-susceptible S. aureus. At EOTT, 30 (65.2%) were considered cured, 9 (19.6%) had an incomplete response, and 7 (15.2%) had died. At the 30-day follow-up after EOTT, 32 were cured (69.6%), 6 (13%) had an incomplete response, and 8 (17.4%) had died. For the 7 patients who died by EOTT, 2 deaths were not associated with infection. While there was no difference in the median length of stay between patients who were cured, had incomplete response, or died, the median duration of TLV therapy for the cured group was 29.5 days (minimum, 4; 25th percentile, 14.75; 75th percentile, 42.0; maximum, 67 days) compared with 11 days (minimum, 1; 25th percentile, 5; 75th percentile, 34; maximum, 47 days) for those with an incomplete response and 4 days (minimum, 1; 25th percentile, 1; 75th percentile, 15; maximum, 15 days) for those who died. Additional antibiotics were permitted prior to, concurrent with, and after TLV. More than 78% of patients received antibiotics prior to TLV (n = 36), 30.4% received antibiotics concurrent with TLV (n = 14), and 19.6% received antibiotics after TLV (n = 9). Five patients received TLV only. The median duration of antibiotics prior to TLV was 4 days (minimum, 1; 25th percentile, 2; 75th percentile, 7.75; maximum, 25 days). The median duration of antibiotics concurrent with TLV was 5 days (minimum, 1; 25th percentile, 1; 75th percentile, 11; maximum, 37 days). The median duration of antibiotics after TLV was 19 days (minimum, 2; 25th percentile, 10.5; 75th percentile, 117.5; maximum, 545 days). When comparing patients who were cured versus those who had an incomplete response, 26 (89.7%) of 29 patients who received TLV longer than any other antibiotic before EOTT were cured compared with 4 (40.0%) of 10 patients who received TLV for a shorter number of days than other antibiotics (P = 0.001). The most common adverse effect was anemia in 9 (19.6%), followed by rises in hepatic enzymes and serum creatinine in 5 (10.9%) each. No adverse events led to the discontinuation of TLV therapy.

Conclusions
Although it is difficult to determine the efficacy of TLV by itself, patients who received TLV for a longer duration than other antibiotics before EOTT were more likely to be cured as opposed to having an incomplete response compared with patients who received TLV as a smaller proportion of their total antibiotic days. A favorable outcome was achieved for many patients receiving the antimicrobial regimen that included TLV for the treatment of methicillin-resistant S. aureus bacteremia.