759. High-Dose Daptomycin Is Well Tolerated via 2-Minute Infusion

Abstract

BackgroundIntravenous (IV) base solution shortages pose issues in the administration of IV antimicrobials and necessitate alternative administration strategies. Safety data supports 2-minute infusions of IV daptomycin up to the labeled dose of 6 mg/kg. The purpose of this study was to evaluate the safety of administering high-dose daptomycin (HDD) (>6 mg/kg) as a 2 minute IV infusion compared with traditional 30-minute infusion.MethodsIRB-approved, retrospective cohort in a five-hospital health system admitted 9/1/17–9/1/18. Inclusion criteria: Patients receiving HDD as either a rapid 2 minute IV push (IVP) or a traditional 30-minute infusion (IVI) while inpatient. Exclusion criteria: <2 doses of HDD, pregnant, age <18, concomitant medication associated with infusion reactions (e.g., amphotericin B or monoclonal antibody). Primary outcome: proportion of patients with infusion-related reactions (IRR) after daptomycin administration. Infusion-related reactions were assessed using the Naranjo algorithm and adjudicated by 2 reviewers blinded to administration strategy. Bivariate statistical tests were used to compare patient characteristics and outcomes between groups. Data were reported using descriptive statistics and measures of central tendency.Results300 patients included: IVP n = 200, IVI n = 100, representing a total of 1697 administrations. Median age IVP 61 (49, 71), IVI 63 (52, 74). Median BMI IVP 28 (23, 35), IVI 27 (23, 32). Median daptomycin dose IVP 700 (550, 900), IVI 700 (600, 900) with mg/kg doses of 8.2 (7.9, 10) and 8.3 (8, 10), respectively. Administration site was similar in both groups with the most common central venous catheters. Potential IRR occurred in 4% of the IVP arm and 1% of IVI arm, P = 0.28. After adjudication, IRR occurred in 1% of both treatment groups. Descriptions of IRR are in Table 1 and only 1 patient in the IVI arm required discontinuation. CPK elevations: 3% of entire cohort.ConclusionAdministering HDD as an IVP was not associated with increased risk of IRR compared with IVI. This administration may be advantageous during fluid shortages and in outpatient administration. Disclosures All authors: No reported disclosures.