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This article is part of the supplement: 30th International Symposium on Intensive Care and Emergency Medicine

Poster presentation

Bacteremic nosocomial pneumonia cases from the ATTAIN studies

E Rubinstein1*, SL Barriere2, FC Genter2, GR Corey3, C Luna4, A Lentnek5 and ME Stryjewski6

  • * Corresponding author: E Rubinstein

Author Affiliations

1 University of Manitoba, Winnipeg, Canada

2 Theravance, Inc., South San Francisco, CA, USA

3 DCRI, Durham, NC, USA

4 University of Buenos Aires, Argentina

5 Wellstar Infectious Disease, Marietta, GA, USA

6 CEMIC, Buenos Aires, Argentina

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Critical Care 2010, 14(Suppl 1):P79  doi:10.1186/cc8311


The electronic version of this article is the complete one and can be found online at: http://ccforum.com/content/14/S1/P79


Published:1 March 2010

© 2010 BioMed Central Ltd.

Introduction

Bacteremic pneumonia is associated with worse outcome including higher mortality. The ATTAIN program compared telavancin (TLV), a lipoglycopeptide antibiotic, with vancomycin (VAN) for treatment of nosocomial pneumonia (NP) due to Gram-positive pathogens including MRSA. This subgroup analysis examined the baseline characteristics and clinical outcomes in bacteremic HAP cases.

Methods

ATTAIN 1 and 2 were methodologically identical, randomized, double-blind, phase 3 studies. Adult patients with NP due to presumed or confirmed Gram-positive pathogens were randomized (1:1) to TLV 10 mg/kg intravenously every 24 hours or VAN 1 g intravenously every 12 hours (adjusted per site-specific guidelines) for 7 to 21 days. The modified all-treated (MAT) population consisted of patients who received ≥1 dose of study medication and who had a respiratory pathogen recovered from baseline cultures. Bacteremic NP was defined by the identification of a pneumonia-causing pathogen in the blood or of the same pathogen in lung and blood with identical susceptibility profiles. Clinical outcomes were assessed at test-of-cure (TOC) 7 to 14 days after end of study treatment.

Results

All MAT patients with bacteremic NP (n = 73) were included in this analysis. At baseline, more TLV patients than VAN patients were in the ICU (TLV 74%, VAN 62%) and had ventilator-associated pneumonia (TLV 59%, VAN 44%); APACHE II scores were similar between groups (mean ± SD, TLV 16 ± 6, VAN 17 ± 6). S. aureus was the most common pathogen (TLV 76%, VAN 69%) and included MRSA (TLV 41%, VAN 49%). Cure rates for TLV and VAN were 44% and 36%, respectively (difference TLV - VAN (95% CI) = 7.3% (-15.9%, 30.5%)). On-study mortality was similar, 41% in each treatment group. Incidences of adverse events (AE) were similar between groups, except for nausea (TLV 21%, VAN 3%) and vomiting (TLV 15%, VAN, 0%). Proportions of patients who discontinued the study medication due to AEs were similar (TLV 12%, VAN 13%).

Conclusions

TLV and VAN had similar cure rates in a subgroup of ATTAIN patients with bacteremic NP. The safety profiles of TLV and VAN were mostly comparable in these patients.