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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.
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.
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%).
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.