Experience with Dalbavancin Use in Various Gram-positive Infections within Aberdeen Royal Infirmary OPAT Service

Abstract

Purpose: dalbavancin, approved in 2014 for Gram-positive acute bacterial skin and skin structure infections (ABSSSI), has pharmacokinetics enabling treatment with one or two doses. Dalbavancin might be useful in outpatient parenteral antibiotic therapy (OPAT) of deep-seated infections otherwise requiring inpatient admission. We documented our experience with pragmatic dalbavancin use to assess its effectiveness for varied indications, on and off label, as primary or sequential consolidation therapy. Methods: patients prescribed dalbavancin between 1st December 2021 and 1st October 2022 were screened for demographics of age, sex, Charlson comorbidity index (CCI), allergies, pathogens, doses of dalbavancin, other antibiotics administered and surgery. Where available, infection markers were recorded. Primary outcome was cure at end of treatment. Secondary outcomes were adverse events and for treatment failures, response to salvage antibiotics. Results: Sixty seven percent of patients were cured. Cure rates by indication were 93 % for ABSSSI, 100 % for bacteraemia, 90 % for acute osteomyelitis, 0 % for chronic osteomyelitis, 75 % for native joint septic arthritis and 33 % for prosthetic joint infection. Most bone and joint infections not cured did not have source control and the goal of treatment was suppressive. Successful suppression rates were greater at 48 % for chronic osteomyelitis and 66 % for prosthetic joint infections. Adverse events occurred in 14 of 102 patients. Conclusion: This report adds to clinical experience with dalbavancin for off label indications whilst further validating its role in ABSSSI. Dalbavancin as primary therapy in deep seated infections merits investigation in formal clinical trials.