Pascale Renato, Maccaro Angelo, Mikus Elisa, Baldassarre Maurizio, Tazza Beatrice, Esposito Fabio, Rinaldi Matteo, Tenti Elena, Ambretti Simone, Albertini Alberto, Viale Pierluigi, Giannella Maddalena, Bartoletti Michele
Infectious Diseases Unit, Department of Integrated Management of Infectious Risk, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
Infectious Diseases Unit, Department of Integrated Management of Infectious Risk, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
J Glob Antimicrob Resist. 2022 Sep;30:390-394. doi: 10.1016/j.jgar.2022.07.018. Epub 2022 Jul 22.
To evaluate the cost-effectiveness of dalbavancin compared with standard of care (SoC) treatment as daptomycin or teicoplanin in patients with sternal wound infections (SWI).
Multicentre retrospective study of patients diagnosed with SWI from January 2016 to December 2019 at two cardiac surgery facilities treated with dalbavancin, teicoplanin or daptomycin. Patients with SWI treated with dalbavancin were compared with SoC to evaluate resolution of infection at 90 and 180 days from infection diagnosis, length of stay (LoS) and management costs.
48 patients with SWI were enrolled, 25 (50%) male, median age 67 (60-73) years, Charlson index score 5 (4-7). Fifteen patients were treated with dalbavancin (31%) and 33 with SoC (69%): teicoplanin in 21 (63%), and daptomycin in 12 (37%). Staphylococcus species were the most frequent isolates (44, 92%), mostly (84%) resistant to methicillin. All patients were treated with surgical debridement followed by negative pressure wound therapy. Wound healing at day 90 and 180 was achieved in 46 (95.8%) and 34 (82.9%) of patients, respectively. A shorter length of hospitalization in patients treated with dalbavancin compared with SoC [12 (7-18) days vs 22 (12-36) days, p:0.009] was found. Treatment with dalbavancin resulted in total cost savings of €16 026 (95% CI 5976-26 076, P < 0.001). Savings were mainly related to the LoS that was significantly shorter in the dalbavancin group, generating significantly lower cost compared to SoC group.
Dalbavancin treatment of sternal wound infections is effective and seems to reduce hospitalization length, leading to significantly lower costs.
评估达巴万星与标准治疗（SoC）（即使用达托霉素或替考拉宁）相比，在治疗胸骨伤口感染（SWI）患者中的成本效益。
对2016年1月至2019年12月期间在两家心脏外科机构被诊断为SWI并接受达巴万星、替考拉宁或达托霉素治疗的患者进行多中心回顾性研究。将接受达巴万星治疗的SWI患者与SoC进行比较，以评估从感染诊断起90天和180天时感染的消退情况、住院时间（LoS）和管理成本。
共纳入48例SWI患者，其中25例（50%）为男性，中位年龄67（60 - 73）岁，Charlson指数评分为5（4 - 7）。15例患者接受达巴万星治疗（31%），33例接受SoC治疗（69%）：21例（63%）接受替考拉宁治疗，12例（37%）接受达托霉素治疗。葡萄球菌属是最常见的分离菌株（44例，92%），大多数（84%）对甲氧西林耐药。所有患者均接受手术清创，随后进行负压伤口治疗。分别有46例（95.8%）和34例（82.9%）患者在第90天和180天时伤口愈合。发现与SoC相比，接受达巴万星治疗的患者住院时间更短[12（7 - 18）天对22（12 - 36）天，p：0.009]。达巴万星治疗使总成本节省了16026欧元（95%CI 5976 - 26076，P < 0.001）。节省主要与达巴万星组明显更短的住院时间有关，与SoC组相比成本显著降低。
达巴万星治疗胸骨伤口感染有效，似乎能缩短住院时间，从而显著降低成本。
