PHILADELPHIA, PA—Ceftaroline fosamil was effective in treating acute bacterial skin and skin structure infections (ABSSSIs) in obese patients and in patients with diabetes, results of a retrospective study presented at IDWeek 2014 has found.
“Clinical success rates were also high in patients with isolation of S. aureus, including MRSA, despite ceftaroline fosamil mostly being used as a second-line therapy,” reported Anathakrishnan Ramini, MD, of Mountain View Medical Practice, Catskill, NY, and colleagues.
Obesity is a risk factor for treatment failure in patients with infections, and those with ABSSSIs and obesity “respond more slowly to treatment and are at risk for morbidity and mortality,” Dr. Ramini noted in explaining the study’s rationale.
Data from the multicenter cohort Clinical Assessment Program and Teflaro Utilization Registry (CAPTURE), a randomly ordered chart review conducted between September 2011 and February 2014, were analyzed to evaluate the effectiveness of ceftaroline fosamil in treating obese patients (BMI ≥30kg/m2) with ABSSSIs.
Of the 1,735 evaluable patients treated for ABSSSI, 883 (51%) were obese, 39% were morbidly obese (BMI ≥ 40kg/m2), and 53% had diabetes mellitus. The majority, 91%, were treated in a general hospital ward; 49% were male; median age at baseline was 58.5 years (range, 18 to 96 years); and mean BMI was 40.8 kg/m2.
Among the 883 patients, infection types included deep/extensive cellulitis (67%), unspecified skin or skin structure infection (33%), major abscesses (15%), infected ulcers (13%), and infected surgical wound (11%).The most common infection sites were the leg/thigh (59%), foot (24%), abdomen (7%), arm or forearm (6%), and buttocks (6%).
Bacterial pathogens were isolated from 47% of patients, MRSA from 20% (93% from the infection site) and MSSA from 11% (97% from the infection site). MRSA was also isolated in blood (8%) and in both ABSSSI site and blood (6%), as was MSSA (8% and 5%, respectively).
In the 80% of patients prescribed antibiotics prior to use of ceftaroline fosamil, most common were vancomycin (53%) and piperacillin-tazobactam (24%). In the 33% of patients who received concomitant ceftaroline fosamil, Clindamycin (19%) and vancomycin (13%) were the antibiotics most commonly prescribed. Mean duration of treatment with ceftaroline fosamil was 5.8 days.
Overall clinical success was 91% for all obese patients, and 90% for the morbidly obese, Dr. Ramini noted. In patients with diabetes, clinical success was 89%.
“In patients who had received antibiotic therapy prior to ceftaroline fosamil, the overall clinical success rate was 92%, and for the morbidity obese subset, 92%,” he noted. In patients with MRSA isolates, clinical success rate was 88% and, for the morbidly obese subset, 85%; for MSSA, this rate was 93% and 97%, respectively. “Clinical success rate was 92% in patients who received ceftaroline fosamil as monotherapy; 92% in the morbidly obese subset.
“Obesity rates are increasing in the US and the treatment of ABSSSI in these patients is often challenging,” Dr. Ramini commented. “These data support the use of ceftaroline fosamil as a treatment option for ABSSSI in patients with obesity, including those with diabetes.”