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Antimicrob Agents Chemother. 2019 Apr 25;63(5). pii: e02280-18. doi: 10.1128/AAC.02280-18. Print 2019 May.

Safety and Efficacy of Prolonged Use of Dalbavancin in Bone and Joint Infections.

Author information

1
Department of Infectious Diseases, Hospital Clínic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain lmorata@clinic.cat.
2
Department of Infectious Diseases, Hospital Ramón y Cajal, Madrid, Spain.
3
Infectious Diseases Unit, Department of Medicine, Hospital Universitario Marques de Valdecilla, Santander, Spain.
4
Department of Infectious Diseases, Complejo Hospitalario Quirón Ruber Juan Bravo, Madrid, Spain.
5
Department of Infectious Diseases, Hospital Universitario de Getafe, Madrid, Spain.
6
Department of Internal Medicine. Instituto de Investigación Sanitaria Hospital 12 de Octubre (i+12), Hospital Universitario 12 de Octubre, Madrid, Spain.
7
Department of Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
8
Department of Infectious Diseases, Hospital Infanta Sofía, Madrid, Spain.
9
Department of Infectious Diseases and Clinical Microbiology, Hospital Universitario La Paz, Madrid, Spain.
10
Clínica Mompía, Santander, Spain.
11
Unit of Infectious Diseases, Internal Medicine, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain.
12
Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville, University of Seville/CSIC/University Hospital Virgen del Rocio, Seville, Spain.
13
Tropical Diseases Unit, Hospital de Poniente, Almería, Spain.
14
Department of Internal Medicine and Infectious Diseases, Hospital Universitario Puerta de Hierro, Madrid, Spain.
15
Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
16
Department of Internal Medicine, Centro Médico Téknon, Barcelona, Spain.
17
Infectious Diseases Unit, Complejo Hospitalario de Jaén, Jaén, Spain.
18
Department of Internal Medicine, Hospital Príncipe de Asturias, Universidad de Alcalá, Madrid, Spain.
19
Unit of Infectious Diseases, Department of Internal Medicine, Complejo Hospitalario Universitario de Toledo, Toledo, Spain.
20
Department of Internal Medicine, Hospital Costa del Sol, Marbella, Spain.
21
Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Hospital Universitario Virgen Macarena, Seville, Spain.
22
Institute of Biomedicine of Seville, University of Seville, Seville, Spain.
23
Unit of Infectious Diseases, Hospital Universitario Cruces, Bilbao, Spain.
24
Department of Internal Medicine, Hospital Vithas Nuestra Señora de Fátima, Pontevedra, Spain.
25
Department of Internal Medicine, Hospital Universitario Severo Ochoa, Madrid, Spain.
26
Department of Internal Medicine, Hospital Universitario Fundación Alcorcón, Alcorcón, Spain.
27
Unit of Infectious Diseases, Internal Medicine, Hospital Universitario Miguel Servet, Zaragoza, Spain.
28
Unit of Infectious Diseases, Hospital Juan Ramón Jiménez, Huelva, Spain.
29
Department of Internal Medicine, General Universitario Ciudad Real, Ciudad Real, Spain.
30
Department of Internal Medicine, Hospital Universitario Arnau de Vilanova, Lleida, Spain.
31
Department of Internal Medicine and Infectious Diseases, Hospital San Carlos, Madrid, Spain.
32
Department of Infectious Diseases, Hospital Clínic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain.

Abstract

Dalbavancin is a lipoglycopeptide with potent activity against Gram-positive microorganisms, a long half-life, a favorable safety profile, and a high concentration in bone, which makes it an interesting alternative for treatment of osteoarticular infections. We performed a multicentric retrospective study of all patients with an osteoarticular infection (septic arthritis, spondylodiscitis, osteomyelitis, or orthopedic implant-related infection) treated with at least one dose of dalbavancin between 2016 and 2017 in 30 institutions in Spain. In order to evaluate the response, patients with or without an orthopedic implant were separated. A total of 64 patients were included. Staphylococcus epidermidis and Staphylococcus aureus were the most frequent microorganisms. The reasons for switching to dalbavancin were simplification (53.1%), adverse events (25%), or failure (21.9%). There were 7 adverse events, and no patient had to discontinue dalbavancin. In 45 cases, infection was related to an orthopedic implant. The implant material was retained in 23 cases, including that in 15 (65.2%) patients that were classified as cured and 8 (34.8%) that presented improvement. In 21 cases, the implants were removed, including those in 16 (76.2%) cases that were considered successes, 4 (19%) cases were considered improved, and 1 (4.8%) case that was considered a failure. Among the 19 cases without implants, 14 (73.7%) were considered cured, 3 (15.8%) were considered improved, and 2 (10.5%) were considered failures. The results show that dalbavancin is a well-tolerated antibiotic, even when >2 doses are administered, and is associated with a high cure rate. These are preliminary data with a short follow-up; therefore, it is necessary to gain more experience and, in the future, to establish the most appropriate dose and frequency.

KEYWORDS:

bone and joint infections; dalbavancin; osteomyelitis; prosthetic joint infection

PMID:
30858217
PMCID:
PMC6496098
[Available on 2019-10-25]
DOI:
10.1128/AAC.02280-18

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