BACTEREMIC HOSPITAL-ACQUIRED PNEUMONIA CASES FROM THE ATTAIN STUDIES

Abstract

PURPOSE: The ATTAIN program compared telavancin (TLV), an investigational lipoglycopeptide antibiotic, with vancomycin (VAN) for treatment of hospital-acquired pneumonia (HAP) 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 HAP due to presumed or confirmed Gram-positive pathogens were randomized (1:1) to TLV 10 mg/kg IV q24 h or VAN 1 g IV q12 h (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 had a pneumonia-causing pathogen identified from blood or same pathogen in lung and blood with identical susceptibility profiles. Clinical outcomes were assessed at test-of-cure (TOC) 7-14 days after end of study treatment. RESULTS: All MAT patients (N = 73) were included in this analysis. At baseline, more TLV patients than VAN patients were in the intensive care unit (TLV 74%, VAN 62%) and had ventilator-associated pneumonia (TLV 59%, VAN 44%) whereas APACHE II scores were similar between groups (mean +/- SD APACHE II score, 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%]). 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 AE were similar (TLV 12%, VAN 13%). CONCLUSION: TLV achieved similar cure rates compared to VAN in a subgroup of ATTAIN patients with bacteremic HAP. The safety profiles of TLV and VAN were mostly comparable among these patients. CLINICAL IMPLICATIONS: TLV has the potential to provide a useful alternative for treatment of patients with bacteremic HAP and randomized controlled trials are warranted.