200. Real-World Experience with Dalbavancin for Complicated Gram-Positive Infections: A Multicenter Evaluation

Abstract

BackgroundDalbavancin (DAL) received Food and Drug Administration (FDA) approval for the treatment of acute bacterial skin and skin structure infections (ABSSSI) caused by Gram-positive organisms including Methicillin-resistant Staphylococcus aureus (MRSA). Due to its unique activity and dosing schedule, use in non-FDA approved indications has been increasing. We evaluated the clinical and safety outcomes of patients treated with DAL for various infections.MethodsA multicenter, retrospective observational study was conducted from April 2017 to February 2019. We included adult patients who received 1 dose of DAL for any indication. The primary outcome was clinical success defined as 30-day survival from DAL initiation, resolution of signs and symptoms of infection, and absence of therapy escalation/change. Reasons for DAL therapy selection were also investigated.ResultsA total of 30 patients were included. The median age was 49 (35–58) years, 50% were female and 93.3% were Caucasian. Median APACHE II score was 9 (5–12). Persons who inject drugs (PWID) comprised 50%. Common DAL indications were bacteremia (53.3%), bone and joint infections (33.3%) and ABSSSI (26.7%). Pathogens were MRSA (43.3%), coagulase-negative Staphylococci (23.3%) and methicillin-susceptible S. aureus (MSSA) (13.3%). Previous antibiotics were administered in 93.3% of patients for a median of 9 (7–15) days and (13.3%) received combination antibiotic therapy with DAL. In a subgroup of patients with confirmed microbiological eradication (73.3%), DAL was initiated at a median of 8 days (4–14) after clearance. Clinical success was achieved in 80% of patients and 10% were de-escalated to oral therapy. Rash/pruritus and hypotension occurred in two and one patient, respectively. DAL was selected because of ease of administration (60%), inability to be discharged with a line (43.3%), poor candidacy for outpatient therapy (36.7%), and/or inadequate adherence (30%).ConclusionDAL appears to be well tolerated and results in high clinical success. Larger studies with longer follow would be valuable to more precisely define the role of DAL in complicated Gram-positive infections, particularly in comparison to other long-acting lipoglycopeptides.Disclosures All authors: No reported disclosures.