PACU Literature Review #13

Sacdal JPA, Cheon E, Stilwell AM, Acquisto NM, Treu CN. Oritavancin versus oral antibiotics for treatment of skin and skin structure infections in the emergency department. Am J Emerg Med. 2022 Jul 8:S0735-6757(22)00448-X. doi: 10.1016/j.ajem.2022.07.013. Epub ahead of print.
PMID: 35835659.

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STUDY OBJECTIVE

• To compare adult ED patients gram-positive SSTI treated with oritavancin to those who required IV antibiotics/hospitalization but left against medical advice (AMA) and therefore received oral antibiotics.

STUDY DESIGN

• Before/After observational study

STUDY INTERVENTION & COMPARISON

• Oritavancin, n=51
• Oral Antibiotics, n=31

RESULTS

• Outcomes
  • ED revisit
    • Oritavancin 16% vs. 36% oral antibiotics (p = 0.06)
  • Hospitalization for worsening infection
    • Oritavancin 12% vs. 26% oral antibiotics (p = 0.13)
  • Secondary Outcomes
    • There was no difference in additional antibiotics within 30 days (both groups 35%).
    • Mean ED LOS was longer for oritavancin patients, 529 ± 126 vs. 448 ± 231 min (p = 0.04).

SUMMARY

• Single-dose oritavancinwas associated with clinically, but not statistically, significant reductions in 30-day ED visits and hospitalizations for worsening infection compared to patients treated with OAB because of refusing hospitalization/leaving AMA. Additional studies in high acuity settings with larger sample sizes are needed to identify the optimal population for oritavancin.

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ADDITIONAL READINGS

• Corey GR, Kabler H, Mehra P, et al. Single-dose oritavancin in the treatment of acute bacterial skin infections. N Engl J Med. 2014;370(23):2180–90..
• Dretske D, Schulz L, Werner E, et al. Effectiveness of oritavancin for management of skin and soft tissue infections in the emergency department: a case series. Am J Emerg Med. 2021;43:77–80.
• Whittaker C, Lodise TP, Nhan E, et al. Expediting discharge in hospitalized, adult patients with skin and soft tissue infections who received empiric vancomycin therapy with Oritavancin: description of findings from an institutional pathway. Drugs Real World Outcomes. 2020;7(Suppl. 1):30–5.

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