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. 2019 Jun;8(2):171-184.
doi: 10.1007/s40121-019-0247-0. Epub 2019 May 3.

Dalbavancin Use in Vulnerable Patients Receiving Outpatient Parenteral Antibiotic Therapy for Invasive Gram-Positive Infections

Jacqueline T Bork  1   2 , Emily L Heil  3 , Shanna Berry  4 , Eurides Lopes  4 , Rohini Davé  5 , Bruce L Gilliam  4 , Anthony Amoroso  4   6
Affiliations

Dalbavancin Use in Vulnerable Patients Receiving Outpatient Parenteral Antibiotic Therapy for Invasive Gram-Positive Infections

Jacqueline T Bork et al. Infect Dis Ther. 2019 Jun.

Abstract

Introduction: Dalbavancin is approved for acute bacterial skin and skin structure infections (ABSSSIs) but offers a potential treatment option for complicated invasive gram-positive infections. Importantly, dalbavancin's real benefits may be in treating complicated infections in vulnerable patient populations, such as persons who inject drugs (PWID).

Methods: A multicenter retrospective analysis was performed from March 2014 to April 2017 to assess 30- and 90-day clinical cure and adverse drug events (ADEs) in adult patients who received ≥ 1 dose of dalbavancin for a non-ABSSSI indication.

Results: During the study period, 45 patients received dalbavancin, 28 for a non-ABSSSI indication. The predominant infections treated included osteomyelitis (46%), endovascular infection (25%) and uncomplicated bacteremia (14%). Half of the patients had positive Staphylococcus aureus in cultures, 29% methicillin resistant and 21% methicillin susceptible. Most patients were prescribed dalbavancin as sequential treatment with a median of 13.5 days of prior antibiotic therapy. The most common reason for choosing dalbavancin over standard therapy use was PWID (54%). Seven patients were lost to follow-up at day 30. Of the remaining evaluable patients, 30-day clinical cure was achieved in 15/21 (71%) patients. The most common reason for failure was lack of source control (4/6, 67%). At day 90, relapse occurred in two patients. Three patients had a potential dalbavancin-associated ADE: two patients with renal dysfunction and one patient with pruritus.

Conclusions: This study demonstrates a possible role for dalbavancin in the treatment of non-ABSSSI invasive gram-positive infections in select vulnerable OPAT patients.

Keywords: Dalbavancin; Outpatient parenteral antibiotic therapy; Substance use disorder.

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Figures

Fig. 1
Fig. 1
Patient selection. ABSSSI acute bacterial skin and skin structure infections
Fig. 2
Fig. 2
Intention-to-treat outcomes by indication. MRSA methicillin-resistant S. aureus
See this image and copyright information in PMC

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