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Lafon-Desmurs B, Gachet B, Hennart B, Valentin B, Roosen G, Degrendel M, Loiez C, Beltrand E, D'Elia P, Migaud H, Robineau O, Senneville E. Dalbavancin as suppressive therapy for implant-related infections: a case series with therapeutic drug monitoring and review of the literature. Eur J Clin Microbiol Infect Dis 2024; 43:1475-1480. [PMID: 38753112 DOI: 10.1007/s10096-024-04849-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 05/07/2024] [Indexed: 07/20/2024]
Abstract
Implant-related infections may need suppressive antibiotic therapy (SAT). We describe a SAT strategy using dalbavancin with therapeutic drug monitoring (TDM). This is a retrospective bicentric study of patients with implant-related infection who received dalbavancin SAT between January 2021 and September 2023. Fifteen patients were included. Median number of injections was 4 (IQR: 2-7). Median time between two reinjections was 57 days (IQR 28-82). Dalbavancin plasma concentrations were above 4 mg/L for 97.9% of dosages (93/95) and above 8 mg/L for 85% (81/95). These results support the use of dalbavancin SAT for implant-related infections.
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Affiliation(s)
- Barthelemy Lafon-Desmurs
- Centre Hospitalier Gustave Dron, Department of Infectious Diseases, Service Universitaire Des Maladies Infectieuses, 59210, Tourcoing, France.
| | - Benoit Gachet
- Centre Hospitalier Gustave Dron, Department of Infectious Diseases, Service Universitaire Des Maladies Infectieuses, 59210, Tourcoing, France
- METRICS ULR 2694, Biostatistics, Lille, France
| | - Benjamin Hennart
- Lille University Hospital, Department of Pharmacology and Toxicology, Lille, France
| | - Benjamin Valentin
- Lille University Hospital, Department of Pharmacology, Lille, France
| | - Gabrielle Roosen
- Centre Hospitalier Gustave Dron, Department of Microbiology, Tourcoing, France
| | - Maxime Degrendel
- Centre Hospitalier Gustave Dron, Department of Infectious Diseases, Service Universitaire Des Maladies Infectieuses, 59210, Tourcoing, France
| | - Caroline Loiez
- Lille University Hospital, Department of Microbiology, Lille, France
| | - Eric Beltrand
- Centre Hospitalier Gustave Dron, Department of Orthopedic Surgery, Tourcoing, France
| | - Piervito D'Elia
- Centre Hospitalier Gustave Dron, Départment of Vascular Surgery, Tourcoing, France
| | - Henri Migaud
- Lille University Hospital, Department of Orthopedic Surgery, Lille, France
| | - Olivier Robineau
- Centre Hospitalier Gustave Dron, Department of Infectious Diseases, Service Universitaire Des Maladies Infectieuses, 59210, Tourcoing, France
- METRICS ULR 2694, Biostatistics, Lille, France
- INSERM UMR-S 1136, Institut Pierre Louis d'Epidémiologie Et de Santé Publique, Paris, France
| | - Eric Senneville
- Centre Hospitalier Gustave Dron, Department of Infectious Diseases, Service Universitaire Des Maladies Infectieuses, 59210, Tourcoing, France
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Pallotto C, Tommasi A, Albagini M, Genga G, Svizzeretto E, Gidari A, Tordi S, Francisci D. Chronic antibiotic suppressive therapy with dalbavancin: a case series. J Chemother 2024:1-5. [PMID: 38712995 DOI: 10.1080/1120009x.2024.2349442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/24/2024] [Indexed: 05/08/2024]
Abstract
Dalbavancin is a relatively new long-acting anti-Gram positive antimicrobial approved for the treatment of acute bacterial skin and skin structures infections. An increasing number of observational studies and case series were published on its off-label uses. Great interest is emerging about complicated cases where antibiotic treatment cannot be discontinued, and a chronic suppressive therapy is needed. We described a case series of 6 patients treated or ongoing on treatment with dalbavancin as chronic suppressive therapy (CAST) administered with the following regimen: dalbavancin 1500 mg on day 1 and 8 and then every 4 weeks. CAST median duration was 27 weeks. Five out of 6 patients reached a good clinical control of the infection (one of them completely resolved) while in one case we observed a recurrence of the infection. No adverse events were detected. Larger studies are needed to better clarify dalbavancin off-label uses and the most appropriate dose regimen.
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Affiliation(s)
- Carlo Pallotto
- Infectious Diseases Clinic, Santa Maria della Misericordia Hospital, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Andrea Tommasi
- Infectious Diseases Clinic, Santa Maria della Misericordia Hospital, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Margherita Albagini
- Infectious Diseases Clinic, Santa Maria della Misericordia Hospital, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Giovanni Genga
- Infectious Diseases Clinic, Santa Maria della Misericordia Hospital, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Elisabetta Svizzeretto
- Infectious Diseases Clinic, Santa Maria della Misericordia Hospital, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Anna Gidari
- Infectious Diseases Unit, Santa Maria Hospital, Department of Medicine and Surgery, University of Perugia, Terni, Italy
| | - Sara Tordi
- Infectious Diseases Clinic, Santa Maria della Misericordia Hospital, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Daniela Francisci
- Infectious Diseases Clinic, Santa Maria della Misericordia Hospital, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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Eckmann C, Sunderkötter C, Becker K, Grabein B, Hagel S, Hanses F, Wichmann D, Thalhammer F. Left ventricular assist device-associated driveline infections as a specific form of complicated skin and soft tissue infection/acute bacterial skin and skin structure infection - issues and therapeutic options. Curr Opin Infect Dis 2024; 37:95-104. [PMID: 38085707 PMCID: PMC10911258 DOI: 10.1097/qco.0000000000000999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
PURPOSE OF REVIEW This review comments on the current guidelines for the treatment of wound infections under definition of acute bacterial skin and skin structure infections (ABSSSI). However, wound infections around a catheter, such as driveline infections of a left ventricular assist device (LVAD) are not specifically listed under this definition in any of the existing guidelines. RECENT FINDINGS Definitions and classification of LVAD infections may vary across countries, and the existing guidelines and recommendations may not be equally interpreted among physicians, making it unclear if these infections can be considered as ABSSSI. Consequently, the use of certain antibiotics that are approved for ABSSSI may be considered as 'off-label' for LVAD infections, leading to rejection of reimbursement applications in some countries, affecting treatment strategies, and hence, patients' outcomes. However, we believe driveline exit site infections related to LVAD can be included within the ABSSSI definition. SUMMARY We argue that driveline infections meet the criteria for ABSSSI which would enlarge the 'on-label' antibiotic armamentarium for treating these severe infections, thereby improving the patients' quality of life.
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Affiliation(s)
- Christian Eckmann
- Academic Hospital of Goettingen University, Department of General, Visceral and Thoracic Surgery, Klinikum Hannoversch-Muenden, Hannoversch-Muenden
| | - Cord Sunderkötter
- Martin-Luther-University Halle-Wittenberg, University and University Hospital of Halle, Department of Dermatology and Venerology, Halle
| | - Karsten Becker
- University Medicine Greifswald, Friedrich Loeffler-Institute of Medical Microbiology, Greifswald
| | - Béatrice Grabein
- LMU Hospital, Clinical Microbiology and Hospital Hygiene, Munich
| | - Stefan Hagel
- Jena University Hospital-Friedrich Schiller University Jena, Institute for Infectious Diseases and Infection Control, Jena
| | - Frank Hanses
- University Hospital Regensburg, Department of Infection Prevention and Infectious Diseases
- University Hospital Regensburg, Emergency Department, Regensburg
| | - Dominic Wichmann
- University Medical Center Hamburg-Eppendorf, Department of Intensive Care Medicine, Hamburg
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Oliva A, Cogliati Dezza F, Cancelli F, Curtolo A, Falletta A, Volpicelli L, Venditti M. New Antimicrobials and New Therapy Strategies for Endocarditis: Weapons That Should Be Defended. J Clin Med 2023; 12:7693. [PMID: 38137762 PMCID: PMC10743892 DOI: 10.3390/jcm12247693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/22/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
The overall low-quality evidence concerning the clinical benefits of different antibiotic regimens for the treatment of infective endocarditis (IE), which has made it difficult to strongly support or reject any regimen of antibiotic therapy, has led to a discrepancy between the available guidelines and clinical practice. In this complex scenario, very recently published guidelines have attempted to fill this gap. Indeed, in recent years several antimicrobials have entered the market, including ceftobiprole, ceftaroline, and the long-acting lipoglycopeptides dalbavancin and oritavancin. Despite being approved for different indications, real-world data on their use for the treatment of IE, alone or in combination, has accumulated over time. Furthermore, an old antibiotic, fosfomycin, has gained renewed interest for the treatment of complicated infections such as IE. In this narrative review, we focused on new antimicrobials and therapeutic strategies that we believe may provide important contributions to the advancement of Gram-positive IE treatment, providing a summary of the current in vitro, in vivo, and clinical evidence supporting their use in clinical practice.
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Affiliation(s)
- Alessandra Oliva
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (F.C.D.); (F.C.); (A.C.); (A.F.); (L.V.); (M.V.)
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Mansoor AER, Krekel T, Cabrera NL. Experience with dalbavancin for long-term antimicrobial suppression of left ventricular assist device infections. Transpl Infect Dis 2023; 25:e14068. [PMID: 37159539 DOI: 10.1111/tid.14068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/01/2023] [Accepted: 04/27/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Left ventricular assist devices (LVAD) are a common strategy for management of end-stage heart failure. LVADs carry a risk of infection of the implanted device components, and skin flora are commonly implicated. Long-term antibiotics may be needed for management of deep device infection or recurrent superficial infections. In appropriately selected patients, dalbavancin can be a feasible option given its extended dosing interval. METHODS This is a retrospective, single-center review of patients presenting with an LVAD infection between January 2011 and November 2022, where management included the use of dalbavancin. Data regarding LVAD placement, details of index infection, dalbavancin use and outcomes was obtained from chart review, and documented in a RedCap database. RESULTS The mean time from LVAD placement to index infection was 131.6 weeks (standard deviation 87.2 weeks). The most common targeted organism was Corynebacterium striatum in six of 10 patients. Index infection presented as deep driveline infection in four patients and recurrent superficial driveline infection in three patients. Five patients had a concurrent bloodstream infection. Dalbavancin was discontinued in two patients due to breakthrough infection, with one patient requiring surgical intervention. No drug-related adverse events were noted. CONCLUSION Dalbavancin is an attractive option in the management of long-term LVAD infection in patients for whom alternative oral or parenteral antibiotics are not a feasible option. Additional studies are needed to determine the optimal dosing of dalbavancin in this setting, and to study adverse events and long-term outcomes of dalbavancin.
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Affiliation(s)
- Armaghan-E-Rehman Mansoor
- Department of Medicine, Division of Infectious Diseases, Washington University, St. Louis, Missouri, USA
| | - Tamara Krekel
- Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, Missouri, USA
| | - Nicolo L Cabrera
- Department of Medicine, Division of Infectious Diseases, Washington University, St. Louis, Missouri, USA
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Pallotto C, Tordi S, Pantanella R, Rosignoli D, Francisci D. Dalbavancin as chronic antibiotic suppression therapy for left ventricular assist device driveline infection due to methicillin-resistant Staphylococcus aureus: a case report. J Chemother 2022:1-5. [PMID: 36281721 DOI: 10.1080/1120009x.2022.2136426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Left Ventricular Assist Devices (LVADs) represent an important therapeutic option in the management of advanced heart failure. We report a case of 74 years-old male with a Jarvik 2000® (Jarvik Heart, New York, USA) LVAD who presented with an infection of the LVAD driveline due to methicillin-resistant Staphylococcus aureus (MRSA) that was treated with dalbavancin as chronic antimicrobial suppression therapy without adverse events and maintaining a good quality of life for more than 37 weeks. Dalbavancin could represent a valid option for the treatment of LVAD infections because of its efficacy, pharmacokinetic/pharmacodynamic proprieties, safety and tolerability.
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Affiliation(s)
- Carlo Pallotto
- Infectious Diseases Clinic, Santa Maria della Misericordia Hospital, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Sara Tordi
- Infectious Diseases Clinic, Santa Maria della Misericordia Hospital, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Romina Pantanella
- Department of Cardiac Surgery, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Daniele Rosignoli
- Infectious Diseases Clinic, Santa Maria della Misericordia Hospital, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Daniela Francisci
- Infectious Diseases Clinic, Santa Maria della Misericordia Hospital, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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Taylor K, Williamson J, Luther V, Stone T, Johnson J, Gruss Z, Russ-Friedman C, Ohl C, Beardsley J. Evaluating the Use of Dalbavancin for Off-Label Indications. Infect Dis Rep 2022; 14:266-272. [PMID: 35447884 PMCID: PMC9026399 DOI: 10.3390/idr14020032] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/31/2022] [Accepted: 03/31/2022] [Indexed: 11/20/2022] Open
Abstract
(1) Background: Dalbavancin is a long-acting lipoglycopeptide antibiotic approved for skin and soft-tissue infections. Post-marketing experience suggests dalbavancin is being used for off-label indications that normally require long-term intravenous (IV) antibiotics; however, data assessing this off-label usage are limited. The purpose of this study was to evaluate the real-world efficacy, safety, and financial impact of off-label dalbavancin use. (2) Methods: This is a retrospective, observational study conducted within a 4-hospital health system. Adult patients who received dalbavancin from January 2018 to January 2021 for an off-label indication were included. The primary outcome was clinical success at 90 days. Secondary outcomes included safety (nephrotoxicity and hepatotoxicity). A pharmacoeconomic analysis was performed by comparing the cost of dalbavancin to the anticipated cost of patient stay if standard IV therapy was given. (3) Results: Forty-eight patients met study criteria. Indications included osteomyelitis (54%), endocarditis (23%), bacteremia (15%), and prosthetic joint infection (8%). The predominant organism was S. aureus (60%), with 42% caused by methicillin-resistant S. aureus. Overall, 41 (85%) patients achieved clinical success at 90 days, including 85% with osteomyelitis, 82% with endocarditis, and 86% with bacteremia. There were no instances of nephrotoxicity or hepatotoxicity. Estimated cost avoidance per patient was USD 5313 and USD 1683 if traditional IV therapy would have been completed in the hospital and skilled nursing facility, respectively. (4) Conclusion: Dalbavancin was associated with a relatively high success rate for the treatment of off-label indications and may be a cost-effective alternative to traditional IV antibiotic therapy.
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Affiliation(s)
- Katherine Taylor
- Wake Forest Baptist Health Department of Pharmacy, Winston-Salem, NC 27157, USA; (J.W.); (T.S.); (J.J.); (J.B.)
- Correspondence:
| | - John Williamson
- Wake Forest Baptist Health Department of Pharmacy, Winston-Salem, NC 27157, USA; (J.W.); (T.S.); (J.J.); (J.B.)
- Section of Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; (V.L.); (C.R.-F.); (C.O.)
| | - Vera Luther
- Section of Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; (V.L.); (C.R.-F.); (C.O.)
| | - Tyler Stone
- Wake Forest Baptist Health Department of Pharmacy, Winston-Salem, NC 27157, USA; (J.W.); (T.S.); (J.J.); (J.B.)
- Section of Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; (V.L.); (C.R.-F.); (C.O.)
| | - James Johnson
- Wake Forest Baptist Health Department of Pharmacy, Winston-Salem, NC 27157, USA; (J.W.); (T.S.); (J.J.); (J.B.)
- Section of Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; (V.L.); (C.R.-F.); (C.O.)
| | - Zachary Gruss
- ProMedica Toledo Hospital Department of Pharmacy, Toledo, OH 43606, USA;
| | - Courtney Russ-Friedman
- Section of Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; (V.L.); (C.R.-F.); (C.O.)
| | - Chris Ohl
- Section of Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; (V.L.); (C.R.-F.); (C.O.)
| | - James Beardsley
- Wake Forest Baptist Health Department of Pharmacy, Winston-Salem, NC 27157, USA; (J.W.); (T.S.); (J.J.); (J.B.)
- Section of Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; (V.L.); (C.R.-F.); (C.O.)
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8
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Gatti M, Andreoni M, Pea F, Viale P. Real-World Use of Dalbavancin in the Era of Empowerment of Outpatient Antimicrobial Treatment: A Careful Appraisal Beyond Approved Indications Focusing on Unmet Clinical Needs. DRUG DESIGN DEVELOPMENT AND THERAPY 2021; 15:3349-3378. [PMID: 34376971 PMCID: PMC8349200 DOI: 10.2147/dddt.s313756] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 07/21/2021] [Indexed: 12/26/2022]
Abstract
Dalbavancin is a novel, long-acting lipoglycopeptide characterized by a long elimination half-life coupled with excellent in vitro activity against multidrug-resistant Gram-positives. Although it is currently approved only for the treatment of acute bacterial skin and skin structure infections, an ever-growing amount of evidence supports the efficacy of dalbavancin as a long-term therapy in osteomyelitis, prosthetic joint infections, endocarditis, and bloodstream infections. This article provides a critical reappraisal of real-world use of dalbavancin for off-label indications. A search strategy using specific keywords (dalbavancin, osteomyelitis, endocarditis, long-term suppressive therapy, bloodstream infection, pharmacokinetic/pharmacodynamic profile) until April 2021 was performed on the PubMed-MEDLINE database. As for other novel antibiotics, a conundrum between approved indications and potential innovative therapeutic uses has emerged for dalbavancin as well. The promising efficacy in challenging scenarios (i.e., osteomyelitis, endocarditis, prosthetic joint infections), coupled with the unique pharmacokinetic/pharmacodynamic properties, makes dalbavancin a valuable alternative to daily in-hospital intravenous or outpatient antimicrobial regimens in the treatment of long-term Gram-positive infections. This makes dalbavancin valuable in the current COVID-19 scenario, in which hospitalization and territorial medicine empowerment are unavoidable.
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Affiliation(s)
- Milo Gatti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.,SSD Clinical Pharmacology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Massimo Andreoni
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.,Infectious Diseases Clinic, University Hospital "Tor Vergata", Rome, Italy
| | - Federico Pea
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.,SSD Clinical Pharmacology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.,Infectious Disease Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Abstract
PURPOSE OF REVIEW The use of durable ventricular assist devices (VAD) to manage end-stage heart failure is increasing, but infection remains a leading cause of morbidity and mortality among patients with VAD. In this review, we synthesize recent data pertaining to the epidemiology, diagnosis, management, and prevention of VAD infections, discuss transplant considerations in patients with VAD infections, and highlight remaining knowledge gaps. We also present a conceptual framework for treating clinicians to approach these infections that draws on the same principles that guide the treatment of analogous infections that occur in patients without VAD. RECENT FINDINGS Despite advances in device design, surgical techniques, and preventative interventions, more than a third of VAD recipients still experience infection as an adverse outcome. Positron emission tomography has emerged as a promising modality for identifying and characterizing VAD infections. High-quality data to support many of the routine therapeutic strategies currently used for VAD infections-including suppressive antibiotic therapy, surgical debridement/device exchange, and novel antimicrobials for emerging multidrug-resistant organisms-remain limited. Although pre-transplant VAD infection may impact some early transplant outcomes, transplantation remains a viable option for patients with most types of VAD infection. Standardized definitions of VAD infection applied to large registry datasets have yielded key insights into the epidemiology of infectious complications among VAD recipients, but more prospective studies are needed to evaluate the effectiveness of existing and novel diagnostic and therapeutic strategies.
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Affiliation(s)
- Varun K Phadke
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA.
| | - Stephanie M Pouch
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
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10
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Dalbavancin as long-term suppressive therapy for patients with Gram-positive bacteremia due to an intravascular source-a series of four cases. Infection 2020; 49:181-186. [PMID: 32965641 PMCID: PMC7850995 DOI: 10.1007/s15010-020-01526-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 09/14/2020] [Indexed: 12/26/2022]
Abstract
We present four cases with Gram-positive bacteremia (pathogens: MRSA n = 1, Enterococcus spp. n = 3) due to an intravascular source (left ventricular assist device: n = 2, transfemoral aortic valve implantation n = 1, prosthetic aortic valve: n = 1) where no curative treatment was available. These patients received indefinite, chronic suppressive (palliative) therapy with dalbavancin (500 mg weekly or 1000 mg biweekly regimens). Outcomes and clinical characteristics are described; treatment was effective in suppression of bacteremia in all patients over several months (range: 1 to more than 12 months), we observed no relevant side effects.
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11
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Bai F, Aldieri C, Cattelan A, Raumer F, Di Meco E, Moioli MC, Tordato F, Morelli P, Borghi F, Rizzi M, Van Hauwermeiren E, Castelli F, Migliorino G, Menzaghi B, Rizzardini G, Saracino A, Cascio A, Puoti M, d'Arminio Monforte A, Marchetti G. Efficacy and safety of dalbavancin in the treatment of acute bacterial skin and skin structure infections (ABSSSIs) and other infections in a real-life setting: data from an Italian observational multicentric study (DALBITA study). Expert Rev Anti Infect Ther 2020; 18:1271-1279. [PMID: 32797758 DOI: 10.1080/14787210.2020.1798227] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES We evaluated the efficacy and safety of dalbavancin in ABSSSI and 'other sites' infections' (OTA). METHODS Observational study involving 11 Italian hospitals including patients that received ≥1 dose of dalbavancin in 2016-2019. The outcome was end-of-treatment efficacy and safety in ABSSSI and OTA in a real-life setting. RESULTS 206 patients enrolled (males 50%, median age 62 [IQR 50-76] years), 60.2% ABSSSI, 39.8% OTA. 69.7% ABSSSI vs 90.7% OTA (p = 0.003) and 46.3% ABSSSI vs 37.2% OTA (p = 0.786) received previous and concomitant antibiotics, respectively. 82.5% reached clinical cure . Eleven (5.4%) patients had non-serious adverse events (AE). OTA patients showed longer hospitalization (13.5 days, 5.5-22 vs 3, 0-11.7; p<0.0001) and received longer previous (18 days, 9-30 vs 11, 7-19; p = 0.007)/concomitant antibiotic treatments (21 days, 14-52 vs 11, 8-14; p < 0.0001), compared to ABSSSI. ABSSSI and OTA showed similar efficacy (85.5% vs 75%, p = 0.459) and safety (no AE: 81.5% vs 64.3%, p = 0.258); efficacy was independent of previous/concomitant therapies. CONCLUSIONS Dalbavancin demonstrated a success rate of >80%, with similar efficacy/safety in ABSSSI and off-label indications. The preferential use of dalbavancin as second-line or combination therapy would seem to suggest the need for in-depth studies focused on its off-label use.
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Affiliation(s)
- Francesca Bai
- Clinic of Infectious Diseases, San Paolo Hospital, ASST Santi Paolo E Carlo, University of Milan , Milan, Italy
| | - Chiara Aldieri
- Clinic of Infectious Diseases, San Paolo Hospital, ASST Santi Paolo E Carlo, University of Milan , Milan, Italy
| | - AnnaMaria Cattelan
- Clinic of Infectious Diseases, Department of Internal Medicine, University Hospital of Padua , Padua, Italy
| | - Francesca Raumer
- Clinic of Infectious Diseases, Department of Internal Medicine, University Hospital of Padua , Padua, Italy
| | - Eugenia Di Meco
- Clinic of Infectious Diseases, Department of Internal Medicine, University Hospital of Padua , Padua, Italy
| | - Maria Cristina Moioli
- Clinic of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda , Milan, Italy
| | - Federica Tordato
- Infectious Diseases Unit, Hospital Health Direction, Humanitas Clinical and Research Center , Milan, Italy
| | - Paola Morelli
- Infectious Diseases Unit, Hospital Health Direction, Humanitas Clinical and Research Center , Milan, Italy
| | - Federica Borghi
- Infectious Diseases Unit, ASST Papa Giovanni XXIII, Bergamo Hospital , Bergamo, Italy
| | - Marco Rizzi
- Infectious Diseases Unit, ASST Papa Giovanni XXIII, Bergamo Hospital , Bergamo, Italy
| | - Evelyn Van Hauwermeiren
- Infectious Diseases Unit, Department of Clinical and Epidemiological Science, ASST Spedali Civili, University of Brescia , Brescia, Italy
| | - Francesco Castelli
- Infectious Diseases Unit, Department of Clinical and Epidemiological Science, ASST Spedali Civili, University of Brescia , Brescia, Italy
| | | | - Barbara Menzaghi
- Infectious Diseases Unit, ASST Valle Olona, Busto Arsizio Hospital , Busto Arsizio, Varese, Italy
| | - Giuliano Rizzardini
- Department of Infectious Diseases, ASST Fatebenefratelli, Luigi Sacco Hospital , Milan, Italy
| | - Annalisa Saracino
- University of Bari 'Aldo Moro', Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari , Bari, Italy
| | - Antonio Cascio
- Dipartimento Di Promozione Della Salute, Materno-Infantile, Di Medicina Interna E Specialistica Di Eccellenza "G. D'Alessandro", University of Palermo , Palermo, Italy
| | - Massimo Puoti
- Clinic of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda , Milan, Italy
| | | | - Giulia Marchetti
- Clinic of Infectious Diseases, San Paolo Hospital, ASST Santi Paolo E Carlo, University of Milan , Milan, Italy
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Thomas G, Henao-Martínez AF, Franco-Paredes C, Chastain DB. Treatment of osteoarticular, cardiovascular, intravascular-catheter-related and other complicated infections with dalbavancin and oritavancin: A systematic review. Int J Antimicrob Agents 2020; 56:106069. [PMID: 32603683 DOI: 10.1016/j.ijantimicag.2020.106069] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/15/2020] [Accepted: 06/21/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is increasing interest in the use of oritavancin and dalbavancin for complicated Gram-positive infections as an alternative to in-hospital intravenous or outpatient antimicrobial therapy. OBJECTIVE To evaluate the efficacy and safety of long-acting lipoglycopeptides (laLGPs) in patients with osteoarticular, cardiovascular, intravascular-catheter-related and other complicated infections. METHODS A systematic literature search was performed using 'dalbavancin' and 'oritavancin' as search terms. For inclusion in this review, studies had to include at least one human subject treated for an indication other than acute bacterial skin and skin structure infections. The primary outcome for this review was clinical success as defined by each individual study, and patients were stratified by type of infection. RESULTS In total, 38 studies (18 randomized controlled trials/case series and 20 case reports) met the inclusion criteria. The most common off-label indication for oritavancin and dalbavancin was osteoarticular infection, with a median success rate of 73% [interquartile range (IQR) 58-85%] among the 14 studies with more than one patient. The success rate for endocarditis and cardiac-device-related infections was 68% (IQR 56-86%) among nine studies, and the success rate for catheter-related bloodstream infection was 75% (IQR 59-90%) among seven studies. Among the 16 studies of almost 700 patients receiving laLGPs, there were 98 reports of adverse events, resulting in 13% of treated patients reporting an event. CONCLUSIONS This review provides evidence that laLGPs are safe and efficacious for osteoarticular, cardiovascular, intravascular-catheter-related and other complicated infections. Further research is needed to confirm these results.
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Affiliation(s)
- Geren Thomas
- John D. Archbold Memorial Hospital, Thomasville, GA, USA
| | | | - Carlos Franco-Paredes
- Division of Infectious Diseases, University of Colorado, Aurora, CO, USA; Hospital Infantil de México, Federico Gómez, México City, México
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