786. Dalbavancin: A Nationwide Outpatient Experience in Physician Office Infusion Centers (POICs)
Session: Poster Abstract Session: Antimicrobial Agents: Novel Agents
Friday, October 9, 2015
Room: Poster Hall
Posters
  • IDWeek 2015_Dalbavancin Poster #786_Van Anglen et al.pdf (485.1 kB)
  • Background: Dalbavancin (DAL), a long-acting lipoglycopeptide, was recently approved for the treatment of acute bacterial skin and skin structure infections caused by susceptible gram-positive bacteria. With weekly administration of two doses, this agent may be beneficial for use in outpatient parenteral antimicrobial therapy (OPAT). We report clinical experience of OPAT use of DAL.

    Methods: A multi-center, retrospective database review was conducted of all patients (pts) receiving DAL in 16 POICs from July 2014 through March 2015. Demographics, therapy characteristics, microbiology, adverse events (AEs), clinical outcomes and recurrences were evaluated.

    Results: DAL was administered to 105 pts with 57 (54%) males and an overall mean age of 62 ± 16 years. Predominant diagnoses were cellulitis (45%), abscess (28%), osteomyelitis (12%), diabetic foot infection (11%) and implanted prosthetic device infection (4%). Forty-nine pts (47%) had DAL therapy initiated in the POIC and 56 pts (53%) received DAL following hospitalization. Fifty-five pts (53%) received other intravenous antibiotics (IVABs) prior to treatment with DAL for a median of 5 days. Eighty-seven pts (83%) received 2 doses of DAL, one week apart. Five pts (5%) received more than 2 doses. Infusions were administered by peripheral intravenous catheter in 84 pts (80%). Among 81 pts with available cultures, methicillin-resistant S. aureus was the most frequent pathogen (48%). Overall clinical success was reported in 88 of 105 pts (84%) with 52% cured and 32% improving. Reasons for failure included disease exacerbation in 6 pts (6%) and serious AEs causing discontinuation of DAL in 10 pts (9%). Of these, 9 of 10 pts had hypersensitivity reactions following the first dose, the majority (67%) occurring in pts receiving other IVABs prior to DAL. Mild to moderate AEs were reported in 28 pts (27%), most commonly diarrhea (n=10), nausea (n=4), dizziness (n=4) and infusion site reactions (n=3). Disease recurrences within 60 days post DAL occurred in 7 of 82 evaluable pts (7%).

    Conclusion: OPAT use of DAL in a physician office setting appears to be safe and effective. AEs were notable, including those requiring DAL discontinuation. The use of DAL may offer added safety and potential cost reductions in this setting due to avoidance of central line catheters. Additional studies are warranted.

    Lucinda J. Van Anglen, PharmD1, Robin H. Dretler, MD, FIDSA2, Quyen Luu, MD3, Ramesh V. Nathan, MD4, Barry Statner, MD, FRCPC, FIDSA4, Fernando S. Alvarado, MD, MPH & TM5 and Claudia P. Schroeder, PharmD, PhD1, (1)Healix Infusion Therapy, Inc., Sugar Land, TX, (2)Infectious Disease Specialists of Atlanta, P.C., Decatur, GA, (3)Quyen Luu, MD, Macon, GA, (4)Mazur, Statner, Dutta, Nathan, PC, Thousand Oaks, CA, (5)Infectious Disease Consultants, MD, PA, Altamonte Springs, FL

    Disclosures:

    L. J. Van Anglen, None

    R. H. Dretler, None

    Q. Luu, None

    R. V. Nathan, Cubist/Merck: Speaker's Bureau , Speaker honorarium

    B. Statner, None

    F. S. Alvarado, None

    C. P. Schroeder, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.