Introduction: Dalbavancin is an antibiotic administered by intravenous infusion weekly or bi-weekly and is currently FDA-approved only for treatment of skin and soft-tissue infections. It has shown promise, but is not considered the standard of care, for bacteremia and infective endocarditis (IE), which typically require outpatient parenteral antibiotic therapy (OPAT) for prolonged durations. People who inject drugs (PWID) with bacteremia or IE are often perceived as having barriers to OPAT and standard daily-administered antibiotics, prompting off-label use of dalbavancin in this population. Methods: A retrospective review of adult patients receiving at least one dose of dalbavancin for bacteremia or IE was conducted between 1 November 2017 and 31 October 2019. Outcomes and reasons for use of dalbavancin were recorded, including specific barriers to standard therapy. Results: Stated reasons for dalbavancin use in the 18 patients identified included active injection drug use (50%), inability to arrange standard OPAT due to patient adherence or inability to place in skilled nursing facility (SNF) (22%), risk for additional infections or other morbidity with OPAT (22%), and patient preference (6%). In 11 patients (61%) SNF placement was not attempted due to behavioral issues or patient declination. There were five patients who did not complete their intended course of treatment (28%). At 90 days, eight patients (44%) achieved a clinical or biologic cure, six (33%) failed treatment, and four (22%) were lost to follow-up. Conclusion: Dalbavancin may have a role as salvage therapy in the treatment of IE and bacteremia in PWID who have significant barriers to standard treatment.

中文翻译：

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达巴万星治疗具有标准护理障碍的人的细菌血症和心内膜炎

简介：达巴万星是一种抗生素，每周或每两周通过静脉输注给药，目前已获得FDA批准，仅用于治疗皮肤和软组织感染。对于菌血症和感染性心内膜炎（IE），它已显示出希望，但未被认为是标准治疗，这些病通常需要长期的门诊肠胃外抗生素治疗（OPAT）。经常将注射有菌血症或IE的药物（PWID）的人视为对OPAT和每日标准使用抗生素的障碍，从而促使该人群超标使用达巴万星。方法：于2017年11月1日至2019年10月31日，对至少接受一剂达巴万星治疗细菌血症或IE的成年患者进行回顾性研究。记录了达巴万星的使用结果和原因，包括对标准疗法的特定障碍。结果：在确定的18例患者中使用达巴万星的陈述原因包括：积极注射药物使用（50％），由于患者依从性而无法安排标准OPAT或无法放置在熟练护理机构（SNF）中（22％），有额外风险OPAT（22％）和患者偏爱（6％）引起的感染或其他疾病。在11例患者（61％）中，由于行为问题或患者偏斜，未尝试放置SNF。有五名患者未完成其预期的治疗过程（28％）。在90天时，有8位患者（44％）获得了临床或生物治愈，六位（33％）治疗失败，四位（22％）失访。结论：