2255. The Use of Dalbavancin for Staphylococcus aureus Bacteremia in Persons Who Inject Drugs (PWID)

Abstract

Background Staphylococcus aureus is a significant cause of bacteremia and is associated with high morbidity and mortality rates. In patients with S. aureus bacteremia, studies have proven that intravenous antibiotics are needed for the entire course of therapy. For some groups of patients, specifically in persons who inject drugs (PWID), the long-term use of IV antibiotics is not safe or feasible. In this population, the current options would be obtaining intravenous access daily for antibiotic infusions, oral antibiotics, or being admitted to a facility that can monitor the patient. Data concerning the utilization of dalbavancin for the treatment of S. aureus bacteremia are limited.MethodsThis was a multicenter, retrospective case series of patients treated with four to six weekly doses of dalbavancin at 5 infusion centers in 3 states under the care of Metro Infectious Disease Consultant (MIDC) physicians between January 1 and December 31, 2018. All patients received intravenous therapy through a peripherally inserted catheter that was removed immediately after the infusion was completed. All patients were evaluated by an MIDC physician at the time of the initial dalbavancin dose, and weekly through their course of therapy. Cure was defined as negative blood cultures and no clinical evidence of persistent or relapsing infection. All patients completed their prescribed dosing and had phone follow-up to assess treatment efficacy at weeks 4, 8, 12, and 24.ResultsTwenty-one patients were included in the analysis. All patients began therapy for S. aureus bacteremia as inpatients and were transitioned to dalbavancin as outpatients. All patients received dalbavancin 1 g followed by 500 mg doses for at least 3 more weeks with an average of 4 weeks of therapy. Of the 21 patients, 16 were able to be contacted post therapy. Of the 16 patients, 2 patients were readmitted within the 6 month time frame for recurrent bacteremia related to intravenous drug usage. The remaining 14 patients remained disease free at the 6 month interval. No patients experienced a line related issue or C. difficile infection during the course of therapy.ConclusionUse of dalbavancin to treat S. aureus bacteremia infections resulted in clinical cure and markedly decreased healthcare costs.Disclosures All authors: No reported disclosures.