EN-DALBACEN 2.0 Cohort: real-life study of dalbavancin as sequential/consolidation therapy in patients with infective endocarditis due to Gram-positive cocci

Abstract

Infective endocarditis (IE) has high mortality and morbidity and requires long hospital stays to deliver the antibiotic treatment recommended in clinical practice guidelines. The objectives were to analyze the health outcomes of the use of dalbavancin (DBV) in the consolidation treatment of IEs caused by Gram-positive cocci (GPC) and to perform a pharmacoeconomic study. Material and methods: This observational, retrospective, Spanish multicenter study in patients with IE who received DBV as part of antibiotic treatment in consolidation phase and were followed for at least 12 months. The study was approved by the Provincial Committee of the coordinating center. Results: The study included 124 subjects, 70.2% male, with a mean age of 67.4 years and median Charlson index of 4 (IQR:2.5-6). Criteria for definite IE were met by 91.1%. Coagulase-negative staphylococci (38.8%), Staphylococcus aureus (22.6%), Enterococcus faecalis (19.4%), Streptococcus spp. (9.7%) were isolated more frequently, all susceptible to vancomycin. Before DVB administration, 91.2% had undergone surgery, 60.5% had received a second regimen for 24.5 days (16.6-56), and 20.2% a third regimen for 14.5 days (12-19.5). DBV was administered to facilitate discharge in 95.2% of cases. At 12 months, the effectiveness was of 95.9%, there was 0.8% loss to follow-up, 0.8% IE-related death and 3.2% relapse. Adverse events were recorded in 3.2%. The hospital stay was reduced by 14 days and there was a mean saving of 5,548.57€/patient versus conventional treatments. Conclusion: DBV is highly effective, safe, and cost-effective as consolidation therapy in patients with IE by GPC, with few adverse events.