JAC Advance Access originally published online on March 5, 2009
Journal of Antimicrobial Chemotherapy 2009 63(5):1034-1042; doi:10.1093/jac/dkp051
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Original research |
Community-based outpatient parenteral antimicrobial therapy (CoPAT) for Staphylococcus aureus bacteraemia with or without infective endocarditis: analysis of the randomized trial comparing daptomycin with standard therapy
1 Department of Infectious Diseases, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA 2 Statistical Consultant, Cubist Pharmaceuticals, 65 Hayden Avenue, Lexington, MA 02421, USA 3 Clinical Development Medical Affairs, Cubist Pharmaceuticals, 65 Hayden Avenue, Lexington, MA 02421, USA 4 Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
Received 12 November 2008; returned 19 December 2008; revised 30 January 2009; accepted 2 February 2009
* Corresponding author. Tel: +1-216-444-6847; Fax: +1-216-444-1010; E-mail: rehms{at}ccf.org
Objectives: Administering outpatient parenteral antimicrobial therapy in the community setting (CoPAT) is becoming more common with the increasing emphasis on controlling costs. However, few controlled trials have evaluated this treatment modality.
Methods: Using data from a recent randomized trial comparing daptomycin with standard therapy (semi-synthetic penicillin or vancomycin, each with initial low-dose gentamicin) for Staphylococcus aureus bacteraemia and infective endocarditis (SAB/IE), patient characteristics and outcomes were evaluated. Patients receiving their full course of therapy in the hospital setting were compared with those who received some portion outside of the hospital (CoPAT).
Results: Among the 200 patients, 51.5% received CoPAT. These patients were generally younger (median age 50 versus 54 years, P = 0.028). In the CoPAT group, there tended to be fewer patients with endocardial involvement (8.7% versus 18.6%, P = 0.061) and pre-existing valvular heart disease (7.8% versus 15.5%, P = 0.120). CoPAT patients received longer therapy courses (mean 25.4 versus 13.5 days, P < 0.001) and had higher rates of therapy completion (90.3% versus 45.4%, P < 0.001) and clinical success (86.4% versus 55.7%, P < 0.001). Persisting or relapsing S. aureus was less frequent in the CoPAT group (3.9% versus 15.5%, P = 0.007) and there were fewer deaths (3.9% versus 18.6%, P = 0.001) 6 weeks after the end of therapy. Hospital readmission occurred for 18 of the 103 (17.5%) CoPAT patients. Clinical success rates were similar for CoPAT patients receiving daptomycin (90.0%) or standard therapy (83.0%).
Conclusions: With proper monitoring, stable patients can complete treatment for SAB/IE as outpatients in the community setting. Daptomycin is an appropriate option for this setting.
Keywords: outcomes , hospital readmission , OPAT , vancomycin , semi-synthetic penicillin
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  D. Nathwani Developments in outpatient parenteral antimicrobial therapy (OPAT) for Gram-positive infections in Europe, and the potential impact of daptomycin J. Antimicrob. Chemother., September 1, 2009; 64(3): 447 - 453. [Abstract] [Full Text] [PDF]
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