Real-world effectiveness of dalbavancin for invasive gram-positive bacterial infections

Abstract

Purpose: Emerging data suggest dalbavancin may be used in complicated infections, including bacteremia, prosthetic joint infections, osteomyelitis, and endovascular infections. This study aimed to evaluate the real-world safety and effectiveness of dalbavancin for the treatment of invasive gram-positive infections (GPIs).

Methods: This multicenter, retrospective cohort study included adult patients who received dalbavancin for treatment of confirmed or presumed invasive GPIs. Patients were excluded if they received dalbavancin for chronic suppression. The intention-to-treat (ITT) population comprised patients who received at least 1 dalbavancin dose. The per-protocol (PP) population received at least 2 doses. The primary outcome was clinical failure in the PP group at 90 days post treatment. Secondary outcomes were the proportion of logistical failures, clinical failures, and treatment-emergent adverse events in the ITT group at 90 days post treatment.

Results: Among the 194 patients included in the PP population, 29.4% (57/194) experienced clinical failure at 90 days post treatment. Active intravenous drug use and lack of reliable transportation were factors significantly associated with higher odds of clinical failure in a multivariable regression model.

Conclusion: Dalbavancin is a safe and effective treatment option for invasive GPIs; however, risk factors are associated with higher odds of clinical failure.

Keywords: Staphylococcus aureus; IVDU; dalbavancin; lipoglycopeptide; transitions of care; treatment failure.