Abstract
Aim
Dalbavancin is a lipoglycopeptide with a half-life of 14 days (range 6.1 to 18.4), significantly longer than other antimicrobials, which avoids the need for daily antibiotic dosing. This multi-centre observational study aims to describe the use of dalbavancin to facilitate discharge in treating bone and joint infections.
Method
All adult patients treated with dalbavancin from January 2017 to September 2022 in four UK bone infection units were included.
Data collected through a standardised data collection form included:
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Clinical and microbiological characteristics.
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Hospital length of stay.
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Complications.
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Patient suitability for hypothetical treatment options, such as Outpatient Parenteral
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Antibiotic Team (OPAT)
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Clinical outcome.
Treatment-related costs were calculated for dalbavancin and the preferred hypothetical treatment option that would have been administered for the same duration. The costs were subtracted to calculate the cost difference.
Clinical success was defined as the absence of definite failure in accordance with the OVIVA Trial protocol.
Results
Thirty-six patients were included: 20 males and 16 females, with a median age of 53 (IQR 43–73): Thirteen were septic arthritis, twelve were prosthetic joints, seven were spondylodiscitis and five were other orthopaedic-related implant infections. In twenty cases the infecting organism was Staphylococcus aureus, fourteen were due to coagulase-negative staphylococci and two no cultured organism.
Reasons for dalbavancin
The reasons for choosing dalbavancin over alternatives were due to either:
Necessity due to poor adherence (21), or lack of viable OPAT options due to antibiotic resistance or intolerance (7)
OR
Convenience to avoid the need for OPAT (8)
Dalbavancin was initiated at 1500mg after a median of 12 days (IQR 6–17) of in-hospital antimicrobial therapy. Subsequent dalbavancin doses were based on clinical decisions and ranged from 1000mg to 1500mg.
Healthcare benefits
Switching to dalbavancin reduced treatment costs by a median of £3526 (IQR 1118 - 6251) compared with the preferred theoretical alternatives. A median of 31 hospital days (IQR 23–47) was avoided among patients who would have required a prolonged inpatient stay.
Outcome
Overall, 20 patients (55.6%) were successfully treated after a median follow-up of 8 months (IQR, 5.8 – 18.4). No patients developed an adverse drug reaction.
Conclusions
Dalbavancin can safely facilitate outpatient treatment in patients with limited oral options and in whom OPAT is unsuitable. Dalbavancin is cost-effective compared with the alternative of an inpatient stay.
