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      A Little Bit of Dalba Goes a Long Way: Dalbavancin Use in a Vulnerable Patient Population

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          Abstract

          Background

          Serious staphylococcal infections require prolonged courses of intravenous (IV) antibiotics. Weekly IV dalbavancin is an alternative to more frequent IV antimicrobial dosing for homeless patients or persons who inject drugs (PWID), for whom creating a treatment plan can be challenging. We examined the clinical outcomes in patients who were treated with dalbavancin compared with a similar population treated with alternative antibiotics.

          Methods

          We identified 18 patients who received dalbavancin from June 1, 2015 to December 31, 2016 using pharmacy records and 89 patients receiving IV antibiotics for similar infections treated at Harborview Medical Center from January 1, 2015 to May 31, 2015, before dalbavancin was available. Medical records were reviewed, and patient demographics, length of stay (LOS), readmission, and outcomes were abstracted using REDCap, linked to the University of Washington’s Clinical Data Repository.

          Results

          Basic demographics in Table 1. The types of infections are in Figure 1. Clinical cure rates were similar between the two groups (Figure 2) although 21% and 28% of the patients were lost to follow-up in the pre and post dalbavancin period. Among the subgroup of PWID, those who received dalbavancin had higher rates of clinical cure (64.7% vs. 29.4%, P = 0.01), a trend toward decreased LOS (11.4 ± 5.8 vs. 20.2 ± 15.1 days, P = 0.04), and fewer 30-day readmissions (0% vs. 29.4%, P = 0.02) (Figure 2). Fewer PWID in the dalbavancin group were lost to follow-up (23.5% vs. 70.6%).

          Conclusion

          Patients treated with dalbavancin had similar outcomes compared with patients treated in the pre-dalbavancin time period. Among PWID, dalbavancin use led to significantly improved outcomes including a higher clinical cure rate, lower readmission rate, and shorter hospital LOS, which offset the cost of the drug. Dalbavancin is an option for the treatment of serious staphylococcal infections in selected patients.

          Table 1: Baseline Characteristics

          Entire Population PWID Population
          Pre-Dalbavancin N = 89 (%) Dalbavancin N = 18 (%) Pre-Dalbavancin N = 17 (%) Dalbavancin N = 17 (%)
          Mean Age in years 51 37 37 36
          Male 64 (71.9) 15 (83.3) 12 (70.6) 14 (82.4)
          Homeless 18 (20.2) 8 (44.4) 9 (52.9) 7 (41.2)
          IDU 17 (19.1) 17 (94.4) 17 (100) 17 (100)

          Abbreviations: IDU= injection drug use.

          Disclosures

          All authors: No reported disclosures.

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          Author and article information

          Journal
          Open Forum Infect Dis
          Open Forum Infect Dis
          ofid
          Open Forum Infectious Diseases
          Oxford University Press (US )
          2328-8957
          Fall 2017
          04 October 2017
          04 October 2017
          : 4
          : Suppl 1 , ID Week 2017 Abstracts
          : S336-S337
          Affiliations
          [1 ] University of Washington , Seattle, Washington
          [2 ] Infectious Disease Clinic, Harborview Medical Center , Seattle, Washington
          [3 ] Harborview Medical Center , Seattle, Washington
          [4 ] Institute of Translational Health Sciences, University of Washington , Seattle, Washington
          [5 ] Division of Allergy and Infectious Disease, University of Washington , Seattle, Washington
          Author notes

          Session: 141. Clinical Practice Issues

          Friday, October 6, 2017: 12:30 PM

          Article
          ofx163.800
          10.1093/ofid/ofx163.800
          5632051
          © The Author 2017. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

          This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence ( http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

          Page count
          Pages: 2
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