1323. Efficacy and Safety of Telavancin Compared to Vancomycin for Cystic Fibrosis Pulmonary Exacerbation in Adults

Abstract Background Telavancin (TLV) is an advanced generation lipoglycopeptide with activity against methicillin-resistant Staphylococcus aureus (MRSA), but there are limited patient outcomes in the setting of cystic fibrosis pulmonary exacerbation (CFPE). The study objective was to compare the efficacy and safety of TLV to vancomycin (VAN) in CFPE. Methods Retrospective cohort conducted from 1/2011-6/2020. Inclusion criteria were: i) age ≥16 years, ii) hospitalized for CFPE with documented signs/symptoms of infection, iii) confirmed or suspected MRSA lower respiratory tract infection, iv) receipt of ≥48 hours of TLV or VAN. The primary outcome was 30-day CFPE-related readmission: infection recurrence, clinical worsening on treatment, or ADE requiring readmission. Secondary outcomes included adverse drug events (ADE) on therapy: acute kidney injury (AKI), rash, thrombocytopenias, cardiac abnormalities. Results 101 patients were included: 52 (52%) TLV, 49 (49%) VAN. The median (IQR) age was 22 (21-27) years, 50% were women, and 86% were Caucasian. The majority (84%) of patients had some federal health insurance; 19% had private health insurance. 93% of patients used a maintenance cystic fibrosis (CF) medication, and 35% had previous CF-therapy compliance concerns. 62% had a previous positive culture for MRSA; 22 (43%) TLV patients had documented MRSA infection on admission compared to 41 (84%) VAN (P< 0.001). The median (IQR) time to TLV initiation from admission was 1 (0.8-1.4) days. 13 patients were readmitted within 30-days due to CFPE; 8 (15)% TLV vs. 5 (10%) VAN (unAdjOR, 0.63; 95%CI, 0.19-2.1). Reasons for 30-day CFPE: TLV: 7 infection recurrence, 1 clinical worsening; VAN: 2 clinical worsening, 2 infection recurrence, 1 treatment-related ADE. When accounting for confounders, TLV was not associated with 30-day CFPE-related readmission (adjOR, 0.34, 95%CI, 0.1-1.2). Patients who received VAN more commonly experienced an ADE while hospitalized (18%), most notably AKI Conclusion TLV was associated with similar short-term clinical outcomes compared to VAN for treatment of CFPE due to confirmed or suspected MRSA. Patients who received TLV experienced fewer overall ADEs. Disclosures Mahmoud Shorman, MD, Cumberland (Grant/Research Support) ghassan wadi, MD, Cumberland (Grant/Research Support) Michael P. Veve, Pharm.D., Cumberland (Grant/Research Support)Paratek Pharmaceuticals (Research Grant or Support)


Complications and Hospital Resource Utilization among Patients with Bacterial Nosocomial Pneumonia in the US, 2012-2019
Marya Zilberberg, MD, MPH 1 ; Brian Nathanson, PhD 2 ; Laura A. Puzniak, PhD 3 ; Noah Zilberberg, n/a 4 ; Andrew F. Shorr, MD, MPH, MBA 5  Background. Nosocomial pneumonia (NP) remains a costly complication of hospitalization. Consisting of hospital-acquired ventilated (vHABP) and non-ventilated (nvHABP), and ventilator-associated (VABP) bacterial pneumonia, these conditions themselves are fraught with further complications. We examined hospital resource utilization (HRU) and the rates of important complications in these three groups in a large US database.
Methods. We conducted a multicenter retrospective cohort study within Premier Research database, a source containing administrative, pharmacy, and microbiology data. The three types of NP were identified based on a slightly modified, previously published ICD-9/10-CM algorithm, 1 and compared with respect to hospital costs, length of stay (LOS) and development of C. difficile infection (CDI), extubation failure (EF), and reintubation (RT). CDI was identified by its treatment with metronidazole, vancomycin, or fidaxomicin. Marginal effects were derived from multivariable regression analyses.
Conclusion. Both HABP and VABP remain associated with significant morbidity and HRU in the US. VABP was associated with the longest post-infection ICU LOS and highest hospital costs.

Session: P-73. Respiratory Infections -Bacterial
Background. Telavancin (TLV) is an advanced generation lipoglycopeptide with activity against methicillin-resistant Staphylococcus aureus (MRSA), but there are limited patient outcomes in the setting of cystic fibrosis pulmonary exacerbation (CFPE). The study objective was to compare the efficacy and safety of TLV to vancomycin (VAN) in CFPE.
Methods. Retrospective cohort conducted from 1/2011-6/2020. Inclusion criteria were: i) age ≥16 years, ii) hospitalized for CFPE with documented signs/symptoms of infection, iii) confirmed or suspected MRSA lower respiratory tract infection, iv) receipt of ≥48 hours of TLV or VAN. The primary outcome was 30-day CFPE-related readmission: infection recurrence, clinical worsening on treatment, or ADE requiring readmission. Secondary outcomes included adverse drug events (ADE) on therapy: acute kidney injury (AKI), rash, thrombocytopenias, cardiac abnormalities.