Dalbavancina long-acting per il trattamento delle infezioni batteriche acute di cute e strutture cutanee (ABSSSI): confronto con gli schemi terapeutici tradizionali
Giulia Magnani, Marco Libanore, Camilla Taglietti, Anna Marra, Francesco Turrini, Brunella Quarta, Rosario Cultrera
Introduction Acute bacterial skin and skin structure infections (ABSSSI) have increased in incidence and severity. The involvement of resistant organisms, particularly methicillin-resistant Staphylococcus aureus, presents additional challenges. Dalbavancin, a lipoglycopeptide antibiotic agent active against gram-positive pathogens, has a prolonged half-life allowing for one shot (one single dose) or once-weekly treatment for ABSSSI. The objective of the analysis was to assess the non-inferiority of dalbavancin when compared with other conventional therapies and evaluate the economic impact of dalbavancin in the hospital setting for patients with ABSSSI.
Methods We retrospectively reviewed patients with ABSSSI hospitalized in Azienda Ospedaliero-Universitaria in Ferrara during 2017-2018. Patients received several antibiotic treatments, including daptomycin, vancomycin, linezolid, tigecycline, clindamycin, amoxicillin/clavulanic acid. The clinical outcome was evaluated considering the clinical improvement, C-reactive protein (CRP) level, adverse effects and recurrences. For the economical evaluation we considered the comparison between the cost of therapy with dalbavancin versus daptomycin.
Results Seventy nine patients with ABSSSI hospitalized between 2017-2018 were analyzed (18 with dalbavancin and 61 patients with conventional treatment). Only the 82% of patients who received conventional treatments had a CRP level decrease compared to 100% of those treated with dalbavancin. The use of intravenous dalbavancin 1,000 mg plus 500 mg once a week versus the use of daptomycin was associated with a cost saving of approximately € 4,400 in a day hospital setting and € 2,400 for an hospitalization of 6 days.
Conclusions Once-weekly intravenous dalbavancin was not inferior to daily intravenous conventional therapies and has the potential of being a cost saving option from a hospital perspective, because the patients with acute bacterial skin and skin structure infections could have discharged earlier.
Key words: ABSSSI, gram-positive infection, dalbavancin, long-acting antibiotic, non-inferiority, early discharge, cost saving