Recurrence of skin infections in patients treated with telavancin versus vancomycin for complicated skin and soft tissue infections in a New Orleans emergency department

Introduction

Telavancin (TLV) is a novel lipoglycopeptide antibiotic that has a multifunctional mechanism to produce rapid bactericidal activity. TLV is highly active against Gram-positive bacteria, including methicillin-resistant and vancomycin (VAN)-intermediate and VAN-resistant strains of Staphylococcus aureus. The recently described community-acquired MRSA is known to have virulence factors associated with multiple lesions and recurrences. The objective of this study was to determine rates of recurrent skin infections within 6 months following treatment with TLV versus VAN.

Methods

A cohort analysis of outcomes was performed in patients from a high-volume inner-city emergency department (ED) in New Orleans, LA, USA. This study was approved by the Human Use Committee (LSUHSC), and informed consent was obtained for all patients. The study included patients enrolled in randomized, double-blind, controlled, phase 2 and 3 multicenter clinical trials. Eligibility criteria included age ≥ 18 years and diagnosis of complicated skin and soft tissue infections caused by suspected or confirmed Gram-positive organisms. Randomization was 1:1 to receive TLV or VAN. ED visit records of enrolled patients were reviewed to determine the number with recurrent skin infections. Data were analyzed by logistic regression.

Results

Ninety-nine patients were randomized and received at least one dose of study medication; 19 patients were not evaluable due to adverse events (AEs), loss to follow-up, or lack of response. Success rates were similar in both analysis populations at the end of therapy: TLV 40/43 (93.0%) versus VAN 35/37 (94.6%). In 68 patients with S. aureus at baseline, 34/35 (97.1%) were cured in the TLV group and 32/33 (97.0%) in the VAN group. For 56 MRSA patients, cure rates were 30/30 (100%) for TLV and 25/26 (96.2%) for VAN. A total of 14 baseline MRSA patients initially cured returned to the ED with a new skin and soft tissue infection: 4/30 (13.3%) patients treated with TLV and 10/26 (38.5%) patients treated with VAN. In a relative risk analysis, TLV-treated patients had a 3.34-fold greater chance of not returning with a recurrent infection than VAN-treated patients (P, 0.04; CI, -1.036, 10.790). The overall incidence of AEs was similar in the two treatment groups: TLV (30%) versus VAN (32.7%).

Conclusion

The results of this study suggest improved long-term eradication of pathogens by TLV based on recurrence of infection within 6 months, and support the development of TLV, especially for infections caused by community-acquired MRSA.