122 - Dalbavancin Use in Patients with Substance Use Disorders

Background: Dalbavancin, a lipoglycopeptide antibiotic, has an extended half-life that allows for weekly dosing and is an alternative to daily intravenous (IV) antibiotics. The dosing interval has the potential to expand treatment options for more severe infections in patients with substance use disorder (SUD), houselessness, and other complex social determinants of health where treatment of severe infections with long courses of IV antibiotics can have a high risk of failure. Questions remain regarding clinical outcomes for this indication and patient population.

Methods: We conducted a retrospective review of dalbavancin use for any patient with documented SUD either by ICD-10 or in chart notes. We identified all patients > 18 years who received > 1 dose of dalbavancin via medication records.

Results: 53 patients with documented SUD received dalbavancin as part of their treatment regimen (Table 1). The most common indication was osteomyelitis, including 14 cases of vertebral osteomyelitis (Table 2). The most common causative organism was Staphylococcus aureus, 23 (43%) cases due to MRSA and 10 (18%) due to MSSA.
The majority of patients (41,77%) had a documented history of IV drug use (IDU) and 19% had alcohol use disorder. A structured, RN-lead multi-disciplinary discharge planning conference to discuss antibiotic options, risk factors for outpatient parenteral antibiotic therapy, and PICC safety in the community was held for 17 (32%).
Concern about outpatient PICC safety in patients with history of IDU, unsafe home environment, and prior non-adherence to outpatient antibiotics were common reasons for choosing dalbavancin. Ten (19%) patients were lost to follow-up. The 30 and 90-day readmission rates were 13% and 19% respectively but were due to relapse or recurrence of infection in only 3 (6%) at 30 days and 2 (4%) additional at 90 days. There was only one death at 90 days ant it was unrelated to infection. (Table 3)Table 1. Patient Demographics
Table 2. Dalbavancin Use
Table 3. Clinical Endpoints


Conclusion: Dalbavancin was well tolerated and = a viable alternative for patients with SUD who often have  social factors and preferences that make continuation of outpatient IV therapy high risk or impractical. Further data on clinical outcomes in complex infections is needed.

Presenting Author(s)

• 

  Amber C. Streifel, PharmD, BCPS

  Infectious Diseases Pharmacist
  Oregon Health & Science University
  Portland, OR

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

  Slides Slides and Audio

Co-Author(s)

• JM

  Jina Makadia, MD

  Infectious Diseases Physician
  Oregon Health and Science University
  Portland, Oregon

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• SL

  Strnad Luke, MD

  Assistant Professor of Medicine
  Oregon Health and Science University and Portland State University School of Public Health
  Portland, Oregon

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• AD

  Alyse Douglass, RN

  Registered Nurse
  Oregon Health and Sciences University
  Portland, Oregon

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• HM

  Heather Mayer, RN

  Registered Nurse
  Oregon Health and Sciences University
  Portland, Oregon

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• KY

  Kathleen Young, RN

  Registered Nurse
  Oregon Health and Sciences University
  Portland, Oregon

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• JL

  James Lewis, PharmD

  Infectious Disease Pharmacist
  Oregon Health and Science University
  Portland, Oregon

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• ES

  Ellie Sukerman, MD

  Assistant Professor of Medicine, Division of Infectious Diseases
  Oregon Health & Science University
  Portland, Oregon

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• 

  Monica K. Sikka, MD

  Assistant Professor of Medicine
  Oregon Health & Science University
  Portland, Oregon

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.