Does ABSSSI Treatment With Oritavancin More Effectively Prevent Bacteremia?

Acute bacterial skin and skin structure infections (ABSSSI) can progress into serious infections such as bacteremia and osteomyelitis in the absence of effective treatment.

Patients with ABSSSI who receive single-dose oritavancin instead of vancomycin with step-down oral antibiotics do not require compliance with outpatient antibiotics. In a new study, a team of investigators set out to determine if oritavancin use can reduce the sequelae from ABSSSI treatment failures, while also preventing infection recurrences and improving patient outcomes.

The results of the study were presented in a poster session at IDWeek 2019.

The retrospective evaluation included patients who received oritavancin or vancomycin for the treatment of ABSSSI between May 2017 and March 2019. The primary end point of the research was to determine the 30-day progression rate from ABSSSI to more serious infections including bacteremia, osteomyelitis, and endocarditis between the 2 treatment arms, as measured by hospital readmissions.

Results indicate that a total of 99 patients who received oritavancin and 100 patients who received vancomycin with step-down oral antibiotics were identified as meeting criteria for inclusion. In the vancomycin arm, 18 of the 100 patients (18%) returned for recurrent ABSSSI infection, while 7 of the 99 patients (7.1%) in the oritavancin arm had a recurrent infection (p = 0.0309).

The investigators used skin and infection and cultures, along with illness history and reported patient compliance to determine the source of each resultant infection. For cases of osteomyelitis, infection location was also considered. The secondary end point was to determine the admission rates between treatment arms for ABSSSI. The investigators analyzed data using fisher’s exact test, chi-square test or t-test as appropriate.

Of the 7 patients in the oritavancin group, 1 patient (14.3%) had bacteremia as a result of persistent ABSSSI. On the other hand, 7 of the 18 returning patients in the vancomycin group returned with bacteremia, including 1 case of osteomyelitis (p = 0.0649).

“Utilizing oritavancin for treatment of ABSSSI in this population resulted in improved patient outcomes, significantly less hospital readmissions for ABSSSI, and decreased infection sequelae from inadequately treated skin infections,” the authors concluded.

The poster, Disease Progression in Patients With Acute Bacterial Skin and Skin Structure Infections: A Comparative Analysis Between Oritavancin and Vancomycin, was presented on Thursday, October 3, 2019, at IDWeek 2019 in Washington, DC.