Successful use of dalbavancin in the treatment of gram positive blood stream infections: a case series

Abstract

Background Dalbavancin is a semisynthetic antibiotic used as an alternative to vancomycin for skin infections and osteomyelitis. Its long half-life decreases length of hospitalizations. This study analyzes the effectiveness of Dalbavancin for bacteremia and infective endocarditis. Methods The authors performed a retrospective chart analysis on patients who received Dalbavancin due to being poor candidates for PICC placement, poor candidates for prolonged hospitalization, or who were leaving against medical advice. Their hospitalizations were analyzed and results were compiled using descriptive statistics. Results Our cohort had 22 patients treated with Dalbavancin for bacteremia and 1 for endocarditis. They were treated with IV antibiotics, typically a regimen of at least vancomycin and a cephalosporin, for a median of 6.5 days prior to receiving Dalbavancin. 20 received one dose, while three received two doses. 22 had confirmed culture clearance and one denied repeat culture. There were no reported side effects from the medication, no readmissions for worsened infection, and no deaths from the infection. 15 patients had follow-up visits within 90 days. Conclusions Overall, patients responded well. The lack of readmission to the hospital indicates possible outpatient treatment. This would help decrease cost and comorbidities of long-term hospital stays. These positive results are limited by small sample size and treatment of other antibiotics prior to receiving Dalbavancin. Further research is required to accurately estimate the efficacy of Dalbavancin on bloodstream infections and endocarditis, but these results are promising especially for patients who are not candidates for long term hospitalization or outpatient IV access.

Dalbavancin Sequential Therapy for Gram-Positive Bloodstream Infection: A Multicenter Observational Study

“…Dalbavancin was found to be non-inferior in patient outcomes and thus subsequently approved for use in SSTI [8]. Once approved, many providers and researchers began to investigate dalbavancin's off-label use among uncomplicated and complicated invasive infections and in vulnerable populations [9][10][11][12][13][14][15][16][17][18][19]. There were positive phase II data showing dalbavancin as non-inferior to vancomycin in 2005 in catheter-associated BSI before the targeted trial for approval was done; however it was likely not a common enough indication for large phase III approval [20].…”

“…A subsequent randomized controlled trial postapproval was developed comparing dalbavancin against standard of care for complicated BSI or infective endocarditis but it was terminated for business reasons in 2017 [21]. At present, evidence regarding dalbavancin as a sequential step-down therapy for invasive infections is limited to case series, single-center observational cohort studies, and small randomized controlled trials focused on osteomyelitis [13][14][15][16][17][18][19]. Questions remain as to the optimal dosing, frequency, and indications for dalbavancin use [22][23][24][25].…”