Dalbavancin versus standard of care for the treatment of osteomyelitis in adults: A retrospective matched cohort study

Objective

To assess the safety and effectiveness of dalbavancin compared to standard of care (SOC) in the treatment of osteomyelitis in adults.

Method

A retrospective cohort study of patients with osteomyelitis due to S. aureus treated with dalbavancin was conducted. Patients who received at least 2 doses of dalbavancin for the treatment of osteomyelitis between January 1, 2015 to January 31, 2018 in a single center in Texas, USA were identified and matched in 1:1 ratio with controls who received SOC. The primary efficacy outcome was the clinical success at the end of treatment. Secondary efficacy outcome was the clinical success continued for at least 3 months after the completion of the antimicrobial therapy.

Results

During study period, 21 patients received dalbavancin for the treatment of osteomyelitis; however, only 11 patients were eligible for inclusion and matched to 11 others who received SOC. Primary outcome was achieved in all 11 patients who received dalbavancin and all those patients subsequently attained the secondary outcome. In SOC group, primary outcome occurred in 82% (9/11) of patients in which 8 out of 9 patients subsequently achieved the secondary outcome. No adverse reaction noted in either group.

Conclusion

Dalbavancin appears to be safe and effective for the management of osteomyelitis in adults. Further studies are needed to confirm these findings.

Complicated Intra-Abdominal Infections: The Old Antimicrobials and the New Players

Complicated intra-abdominal infections (cIAIs) are an important cause of morbidity and mortality worldwide. They are diagnosed when the initial abdominal organ infection has spread into the peritoneal space. Successful treatment relies on adequate source control and appropriate empiric antimicrobial therapy. Inappropriate antimicrobial therapy may result in poor patient outcomes and increases in healthcare costs. Current guidelines recommend several single and combination antimicrobial regimens; however, empiric antimicrobial treatment has been complicated by the increasing rates of resistant organisms, especially the extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae. Additionally, the overuse of carbapenems to combat these resistant pathogens has contributed to the rise of carbapenemase-producing microorganisms, especially Klebsiella pneumoniae. This increasing resistance has prompted the development of novel antimicrobials like ceftazidime-avibactam and ceftolozane-tazobactam, whose activity extends to ESBL-producing microorganisms. Furthermore, the optimal duration of antimicrobial therapy is still unknown, and further research is necessary to find a definitive answer. This review will focus on antimicrobial therapies recommended by the current guidelines, the individual properties of these agents, appropriate duration of therapy, recent clinical trials, and place in therapy of the antimicrobial agents recently approved for the treatment of cIAIs.