264 - Anti-platelet Therapy Significantly Reduces Inpatient Mortality in Patients with Staphylococcus aureus Bacteremia

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Co-Author(s)

Aisling R. Caffrey

Director of Outcomes Research
1. Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Providence, RI, United States 2. Center of Innovation in Long-Term Support Services, Providence Veterans Affairs Medical Center, Providence, RI, United States 3. College of Pharmacy, University of Rhode Island, Kingston, RI, United States 4. School of Public Health, Brown University, Providence, RI
Kingston, Rhode Island
Disclosure: Merck (Research Grant or Support)Pfizer (Research Grant or Support)Shionogi (Research Grant or Support)
Emily T. O'Neill

Infectious Diseases Post-Doctoral Fellow
1. Providence Veterans Affairs Medical Center, Providence, RI, United States 2. College of Pharmacy, University of Rhode Island, Kingston, RI, United States
Providence, Rhode Island
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
VL

Vrishali V. Lopes

Research Analyst
1. Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Providence, RI, United States
Providence, Rhode Island
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Erlinda R. Ulloa

Assistant Professor
University of California Irvine
San Diego, California
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
GS

George Sakoulas

Associate Adjunct Professor
5. University of California, San Diego School of Medicine, La Jolla, CA, United States
La Jolla, California
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Victor Nizet

Distinguished Professor and Vice Chair
University of California San Diego
San Diego, CA
Disclosure: Centauri Therapeutics (Advisor or Review Panel member)Cidara Therapeutics (Advisor or Review Panel member)InhibRx (Advisor or Review Panel member)Roche Pharmaceutical (Advisor or Review Panel member)

Presenting Author(s)

Kerry L. LaPlante

Professor and Chair
1. Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Providence, RI, United States 2. Center of Innovation in Long-Term Support Services, Providence Veterans Affairs Medical Center, Providence, RI, United States 3. College of Pharmacy, University of Rhode Island, Kingston, RI, United States 5. Warren Alpert Medical School of Brown University, Division of Infectious Diseases, Providence, RI
Kingston, Rhode Island
Disclosure: Merck (Advisor or Review Panel member, Research Grant or Support)Ocean Spray Cranberries, Inc. (Research Grant or Support)Pfizer Pharmaceuticals (Research Grant or Support)Shionogi, Inc. (Research Grant or Support)

Background: There is a growing body of evidence which suggests that P2Y12 inhibitors may have antibacterial properties in vivo. To our knowledge, this has not been previously examined using real world clinical data from patients with specific infections.

Methods: Our retrospective cohort study included patients admitted to Veterans Affairs hospitals between 2010-2018 with blood cultures positive for S. aureus and treated with appropriate antibiotics within 48 hours of culture collection. We included patients treated with P2Y12 inhibitors for at least the 30 days prior to admission and continued use for at least 5 days after admission. Non-users included patients without P2Y12 inhibitor use in the year prior to admission through discharge. We compared clinical outcomes during the S. aureus bacteremia admission among P2Y12 users and non-users using propensity score matched Cox proportional hazards regression models.

Results: We identified 371 P2Y12 inhibitor users (clopidogrel, prasugrel, ticagrelor, cangrelor) and 13,298 non-users. Mean age was 70 years and 69 years, respectively. Over 98% were male in both the groups, and the overall inpatient mortality rate was 8.7%. We were able to match 199 users and non-users, which were well matched in terms of baseline covariates. Inpatient mortality was significantly lower among P2Y12 inhibitor users (hazard ratio [HR] 0.08, 95% confidence interval [CI] 0.01-0.64), and 30-day mortality was non-significantly lower (HR 0.57, 95% CI 0.31-1.03). There was no difference between the groups in readmission or re-infection within 30 days of discharge.

Conclusion: Among patients with S. aureus bacteremia, those treated with P2Y12 inhibitors in the days leading up to admission and continuing through the initial period of antibiotic treatment, had a 92% lower risk of inpatient mortality. Identifying adjunctive therapies which improve clinical outcomes among patients with S. aureus bacteremia is highly important in order to improve patient outcomes and to increase the understanding of the pathophysiology of the disease. Prospective clinical studies are needed to further define the potential benefits of P2Y12 inhibitors in S. aureus bacteremia and possibly other infection types.