Pharmacy, Hospital Universitario 12 de Octubre, Madrid, Spain
Pharmacy, Hospital Universitario 12 de Octubre, Madrid, Spain.
Eur J Hosp Pharm. 2022 Jan;29(1):55-58. doi: 10.1136/ejhpharm-2020-002315. Epub 2020 Oct 5.
Dalbavancin is approved for the treatment of complicated skin and soft tissue infections. However, there is growing evidence that other gram-positive infections could be treated with this antibiotic. A study was undertaken in a tertiary hospital in Spain to evaluate the effectiveness and safety of dalbavancin in off-label indications and the potential healthcare cost savings.
A retrospective observational study including all patients treated with dalbavancin in our hospital from October 2016 to August 2019 was carried out. Demographic, clinical and safety variables were collected. Effectiveness was assessed using the clinical and microbiological resolution of the infection and the absence of hospital admissions due to the same infection in the following 3 months.
A total of 102 patients were included (69.9% men, n=71; median age 72.5 years (range 56.0-84.0)). Treatment was off label in 71 cases (69.6%). The most frequent off-label indications were catheter-related bacteraemia (15.7%, n=16) and endocarditis (13.6%, n=14). All patients had previously received antibiotics. The main reason for switching to dalbavancin was patient discharge (79.4%, n=81). Dalbavancin was administered during hospitalisation in 66.7% of the patients and in the outpatient setting in 13.7%. The median reduction in length of hospital stay was 14 days per patient. A saving of about 4550 Euros per patient was estimated. 89 patients (93.7%) had clinical and microbiological resolution of the infection at the end of the study. One patient did not finish the dalbavancin infusion due to an allergic reaction.
Our results suggest that dalbavancin is a safe and effective alternative to the off-label treatment of gram-positive infections. Its dosage facilitates early discharge and outpatient management of these patients.
达巴万星获批用于治疗复杂性皮肤和软组织感染。然而，越来越多的证据表明，其他革兰氏阳性感染也可以用这种抗生素治疗。西班牙一家三级医院开展了一项研究，旨在评估达巴万星治疗非适应证的有效性和安全性，以及潜在的医疗成本节约。
本回顾性观察性研究纳入了 2016 年 10 月至 2019 年 8 月期间在我院接受达巴万星治疗的所有患者。收集了人口统计学、临床和安全性变量。通过感染的临床和微生物学缓解以及在接下来的 3 个月内因同一感染而无住院治疗来评估疗效。
共纳入 102 例患者（69.9%为男性，n=71；中位年龄 72.5 岁（范围 56.0-84.0））。71 例（69.6%）治疗为超适应证。最常见的超适应证包括导管相关菌血症（15.7%，n=16）和心内膜炎（13.6%，n=14）。所有患者均曾接受过抗生素治疗。改用达巴万星的主要原因是患者出院（79.4%，n=81）。66.7%的患者在住院期间接受达巴万星治疗，13.7%的患者在门诊接受治疗。中位每位患者的住院时间缩短 14 天。估计每位患者可节省约 4550 欧元。研究结束时，89 例（93.7%）患者的感染达到临床和微生物学缓解。1 例患者因过敏反应未完成达巴万星输注。
我们的研究结果表明，达巴万星是治疗革兰氏阳性感染的一种安全有效的替代方案。其剂量有利于这些患者的早期出院和门诊管理。
