Real-world experience with dalbavancin therapy in gram-positive skin and soft tissue infection, bone and joint infection

• Published in: Infection 2019-12, Vol.47 (6), p.1013-1020
• Main Authors: Tobudic, Selma, Forstner, Christina, Burgmann, Heinz, Lagler, Heimo, Steininger, Christoph, Traby, Ludwig, Vossen, Mathias G., Winkler, Stefan, Thalhammer, Florian
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Antibiotics; Arthritis; Austria; Biofilms; Biomedical materials; Chronic infection; Exanthema; Family Medicine; Female; General Practice; Gram-Positive Bacterial Infections - drug therapy; Gram-Positive Bacterial Infections - microbiology; Humans; Hyperglycemia; Infections; Infectious Diseases; Internal Medicine; Joint diseases; Joints (anatomy); Male; Medicine; Medicine & Public Health; Middle Aged; Nausea; Oral administration; Original Paper; Osteomyelitis; Patients; Prostheses; Retrospective Studies; Side effects; Skin; Skin Diseases, Infectious - drug therapy; Skin Diseases, Infectious - microbiology; Soft Tissue Infections - drug therapy; Soft Tissue Infections - microbiology; Soft tissues; Spondylodiscitis; Teicoplanin - analogs & derivatives; Teicoplanin - therapeutic use; Therapy; Young Adult
• ISSN: 0300-8126; 1439-0973
• DOI: 10.1007/s15010-019-01354-x

Purpose Dalbavancin is a novel lipoglycopeptide with potent activity against several gram-positive pathogens, an excellent safety profile and a long elimination half-life. Methods In this case series observed at the University Hospital of Vienna between 2015 and 2017, all adult patients with gram-positive infections who received at least one dosage of dalbavancin were screened ( n  = 118). A total of 72 patients were included in the final analysis. The number of included patients stratified by the source of infection was: skin and soft tissue infection (SSTI) ( n  = 26), osteomyelitis ( n  = 20), spondylodiscitis ( n  = 14), acute septic arthritis ( n  = 4) and prosthetic joint infection ( n  = 8). Results In 46 patients (64%), clinical cure was detected at the end of dalbavancin therapy without additional antibiotic therapy. Of the 26 patients who received additional antibiotic therapy other than dalbavancin, 15 patients (21%) showed no clinical improvement under dalbavancin therapy, four patients (5%) had side effects (nausea n  = 1, exanthema n  = 2, hyperglycemia n  = 1), and in seven patients (10%) clinical improvement under dalbavancin therapy was detected but antibiotic therapy was de-escalated to an oral drug. Conclusion We demonstrated high clinical effectiveness of dalbavancin for acute gram-positive infections primarily acute SSTI, acute septic arthritis, acute osteomyelitis and spondylodiscitis. In patients with biofilm-associated infection (chronic infection or joint prosthesis), source control was absolutely necessary for treatment success.