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Wound Infection Case Study

64-year old female with BMI 34 kg/m2 on warfarin

Background

  • Patient is a 64-year-old obese female, BMI 34 kg/m2. She is a diabetic on insulin and also has polyvascular disease. She has a history of deep vein thrombosis with an inferior vena cava (IVC) filter, and is on warfarin.

Presentation

  • Patient presented to ED with an infection at the site of prior bariatric abdominal surgery wound. There were insulin injections in this area. She had low grade fever, elevated blood sugar and decreased appetite.

Evaluation

  • Lesion size: 210 cm2
  • BP: 110/68 mmHG
  • RR: 21/min
  • HR: 112/min
  • Current BMI: 34 kg/m2
  • Temp: 99.7° F
  • WBC: 13,400/mcL
  • Blood glucose: 200 mg/dl
  • CrCl: 30 mL/min
  • Taking insulin, low-dose aspirin, warfarin and ACE inhibitor

Diagnosis and treatment considerations

  • Surgical wound infection
  • Presumed gram-positive cocci, presumed MRSA
  • Physician feels severity of infection warrants an IV antibiotic
  • Patient prefers not to be admitted or have to return for multiple infusions

Resolution of wound infection following administration of single dose ORBACTIV®

At presentation

Actual SOLO patient picture

48-72 hours

Actual SOLO patient picture

7-10 days

Actual SOLO patient picture

14-24 days

Actual SOLO patient picture

This hypothetical case study is meant to be illustrative of an actual patient treated with a single 1200mg dose of ORBACTIV® in the SOLO trials. It is not intended to offer medical advice. Determination of appropriate treatment is at the discretion of the physician. Results presented are consistent with results observed in the SOLO trials of patients with ABSSSI. In the SOLO I and SOLO II trials the clinical response rates at 14-24 days for patients receiving ORBACTIV® were 79.6% and 82.7% respectively. Click here to see clinical study results from the SOLO trials. Individual results may vary.

Download a PDF of this case study here.

Background

  • Patient is a 64-year-old obese female, BMI 34 kg/m2. She is a diabetic on insulin and also has polyvascular disease. She has a history of deep vein thrombosis with an inferior vena cava (IVC) filter, and is on warfarin.

Presentation

  • Patient presented to ED with an infection at the site of prior bariatric abdominal surgery wound. There were insulin injections in this area. She had low grade fever, elevated blood sugar and decreased appetite.

Evaluation

  • Lesion size: 210 cm2
  • BP: 110/68 mmHG
  • RR: 21/min
  • HR: 112/min
  • Current BMI: 34 kg/m2
  • Temp: 99.7° F
  • WBC: 13,400/mcL
  • Blood glucose: 200 mg/dl
  • CrCl: 30 mL/min
  • Taking insulin, low-dose aspirin, warfarin and ACE inhibitor

Diagnosis and treatment considerations

  • Surgical wound infection
  • Presumed gram-positive cocci, presumed MRSA
  • Physician feels severity of infection warrants an IV antibiotic
  • Patient prefers not to be admitted or have to return for multiple infusions

INDICATION AND USAGE

ORBACTIV® (oritavancin) for injection is indicated for the treatment of adult patients with acute bacterial skin and skin structure infections (ABSSSI) caused or suspected to be caused by susceptible isolates of the following gram-positive microorganisms: Staphylococcus aureus (including methicillin-susceptible [MSSA] and -resistant [MRSA] isolates), Streptococcus pyogenes, Streptococcus agalactiae, Streptococcus dysgalactiae, Streptococcus anginosus group (includes S. anginosus, S. intermedius, and S. constellatus), and Enterococcus faecalis (vancomycin-susceptible isolates only).

To reduce the development of drug-resistant bacteria and maintain the effectiveness of ORBACTIV® and other antibacterial drugs, ORBACTIV® should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria.

Important Safety Information

Contraindications

Use of intravenous unfractionated heparin sodium is contraindicated for 120 hours (5 days) after ORBACTIV® administration because the activated partial thromboplastin time (aPTT) test results may remain falsely elevated for approximately 120 hours (5 days) after ORBACTIV® administration.

ORBACTIV® is contraindicated in patients with known hypersensitivity to oritavancin products.

Warnings and Precautions

Coagulation test interference: Oritavancin has been shown to artificially prolong aPTT for up to 120 hours and may prolong PT and INR for up to 12 hours, and ACT for up to 24 hours. Oritavancin has also been shown to elevate D-dimer concentrations up to 72 hours. For patients who require aPTT monitoring within 120 hours of oritavancin dosing, consider a non-phospholipid dependent coagulation test such as a Factor Xa (chromogenic) assay or an alternative anticoagulant not requiring aPTT.

Serious hypersensitivity reactions, including anaphylaxis, have been reported with the use of oritavancin products, including ORBACTIV®. Discontinue infusion if signs of acute hypersensitivity occur. Closely monitor patients with known hypersensitivity to glycopeptides.

Infusion Related Reactions: Administer ORBACTIV® over 3 hours to minimize infusion-related reactions. Infusion reactions characterized by chest pain, back pain, chills and tremor have been observed with the use of oritavancin products (e.g. ORBACTIV®), including after the administration of more than one dose of oritavancin during a single course of therapy. Stopping or slowing the infusion may result in cessation of these reactions.

Clostridioides difficile-associated diarrhea: Evaluate patients if diarrhea occurs.

Concomitant warfarin use: Oritavancin has been shown to artificially prolong PT/INR for up to 12 hours. Patients should be monitored for bleeding if concomitantly receiving ORBACTIV® and warfarin.

Osteomyelitis: Institute appropriate alternate antibacterial therapy in patients with confirmed or suspected osteomyelitis.

Prescribing ORBACTIV® in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of development of drug-resistant bacteria.

Adverse Reactions

The most common adverse reactions (≥3%) in patients treated with ORBACTIV® were headache, nausea, vomiting, limb and subcutaneous abscesses, and diarrhea.

Please see Full Prescribing Information for ORBACTIV®.

INDICATION AND USAGE

ORBACTIV® (oritavancin) for injection is indicated for the treatment of adult patients with acute bacterial skin and skin structure infections (ABSSSI) caused or suspected to be caused by susceptible isolates of the following gram-positive microorganisms: Staphylococcus aureus (including methicillin-susceptible [MSSA] and -resistant [MRSA] isolates), Streptococcus pyogenes, Streptococcus agalactiae, Streptococcus dysgalactiae, Streptococcus anginosus group (includes S. anginosus, S. intermedius, and S. constellatus), and Enterococcus faecalis (vancomycin-susceptible isolates only).

To reduce the development of drug-resistant bacteria and maintain the effectiveness of ORBACTIV® and other antibacterial drugs, ORBACTIV® should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria.