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Abstract：
BACKGROUND: Approved for acute bacterial skin and skin structure infections, dalbavancin (DBV) has gradually acquired over the years a role as an off-label treatment for several infections caused by Gram-positive bacteria even in other anatomical sites. Osteoarticular (OA) infections are one of the most difficult-to-treat infections and, since the absence of recommendations, clinicians use different and heterogenic DBV dosing schedule regimens for the off-label treatment of osteomyelitis, spondylodiscitis, and septic arthritis. Our aim is to systematically review the current literature to describe DBV administration schedules and their outcome in OA infections.
METHODS: According to the 2020 updated PRISMA guidelines, all peer-reviewed articles regarding the use of DBV in OA infections were included. We conducted a literature search on PubMed and Cochrane Controlled Trials.
RESULTS: A total of 23 studies and 450 patients were included, prevalently male (144/195, 73.8%) and diabetic (53/163, 32.5%). Overall, 280 (280/388, 72.2%) osteomyelitis, 79 (79/388, 20.4%) spondylodiscitis, and 29 (29/388, 7.5%) septic arthritis were considered. Staphylococcus aureus (164/243, 67.5%) was the most common pathogen isolated. A previous treatment failure (45/96, 46.9%) was the main reason for a switch to a long-acting antibiotic. Most patients were successfully cured with DBV (318/401, 79.3%). A source control was performed in most patients with a favourable outcome (80.4%), while MRSA was prevalently isolated in people with an unfavourable outcome (57%). While a higher percentage of success was found in people who received three doses of DBV 1 week apart (92.3%), a higher rate of treatment failure was recorded in cases of when the DBV cycle was composed of less than two or more than four doses (27.8%).
CONCLUSIONS: DBV has shown to be effective as a treatment for OA infections. The most favourable outcome was found in patients receiving three doses of DBV and with an adequate surgical management prior to antibiotic treatment. Although a rigorous administration schedule does not exist, DBV is a viable treatment option in the management of OA infections.
METHODS: According to the 2020 updated PRISMA guidelines, all peer-reviewed articles regarding the use of DBV in OA infections were included. We conducted a literature search on PubMed and Cochrane Controlled Trials.
RESULTS: A total of 23 studies and 450 patients were included, prevalently male (144/195, 73.8%) and diabetic (53/163, 32.5%). Overall, 280 (280/388, 72.2%) osteomyelitis, 79 (79/388, 20.4%) spondylodiscitis, and 29 (29/388, 7.5%) septic arthritis were considered. Staphylococcus aureus (164/243, 67.5%) was the most common pathogen isolated. A previous treatment failure (45/96, 46.9%) was the main reason for a switch to a long-acting antibiotic. Most patients were successfully cured with DBV (318/401, 79.3%). A source control was performed in most patients with a favourable outcome (80.4%), while MRSA was prevalently isolated in people with an unfavourable outcome (57%). While a higher percentage of success was found in people who received three doses of DBV 1 week apart (92.3%), a higher rate of treatment failure was recorded in cases of when the DBV cycle was composed of less than two or more than four doses (27.8%).
CONCLUSIONS: DBV has shown to be effective as a treatment for OA infections. The most favourable outcome was found in patients receiving three doses of DBV and with an adequate surgical management prior to antibiotic treatment. Although a rigorous administration schedule does not exist, DBV is a viable treatment option in the management of OA infections.
摘要：
背景：批准用于急性细菌性皮肤和皮肤结构感染，多年来，dalbavancin（DBV）已逐渐获得了作为由革兰氏阳性细菌引起的几种感染的超标签治疗的作用，即使在其他解剖部位也是如此。骨关节（OA）感染是最难以治疗的感染之一，由于缺乏建议，临床医生使用不同的和异源性DBV给药方案治疗骨髓炎，脊椎盘炎,和脓毒性关节炎.我们的目的是系统地回顾目前的文献，以描述DBV的给药方案及其在OA感染中的结果。
方法：根据2020年更新的PRISMA指南，纳入了所有同行评审的关于在OA感染中使用DBV的文章.我们对PubMed和Cochrane对照试验进行了文献检索。
结果：共纳入23项研究和450例患者，主要为男性（144/195，73.8%）和糖尿病（53/163，32.5%）。总的来说,280（280/388，72.2%）骨髓炎，79（79/388，20.4%）脊椎盘炎，和29（29/388，7.5％）化脓性关节炎被认为。金黄色葡萄球菌（164/243，67.5％）是最常见的病原体。以前的治疗失败（45/96，46.9％）是转换为长效抗生素的主要原因。大多数患者使用DBV成功治愈（318/401，79.3％）。在大多数预后良好的患者中进行了源控制（80.4％），而MRSA在结局不利的人群中普遍分离(57%).虽然在间隔1周接受三剂DBV的人中发现了更高的成功率（92.3％），当DBV周期的剂量少于2次或多于4次(27.8%)时,治疗失败率较高.
结论：DBV已显示可有效治疗OA感染。在接受三剂DBV并在抗生素治疗之前进行适当的手术管理的患者中发现了最有利的结果。尽管不存在严格的管理时间表，DBV是治疗OA感染的可行选择。
方法：根据2020年更新的PRISMA指南，纳入了所有同行评审的关于在OA感染中使用DBV的文章.我们对PubMed和Cochrane对照试验进行了文献检索。
结果：共纳入23项研究和450例患者，主要为男性（144/195，73.8%）和糖尿病（53/163，32.5%）。总的来说,280（280/388，72.2%）骨髓炎，79（79/388，20.4%）脊椎盘炎，和29（29/388，7.5％）化脓性关节炎被认为。金黄色葡萄球菌（164/243，67.5％）是最常见的病原体。以前的治疗失败（45/96，46.9％）是转换为长效抗生素的主要原因。大多数患者使用DBV成功治愈（318/401，79.3％）。在大多数预后良好的患者中进行了源控制（80.4％），而MRSA在结局不利的人群中普遍分离(57%).虽然在间隔1周接受三剂DBV的人中发现了更高的成功率（92.3％），当DBV周期的剂量少于2次或多于4次(27.8%)时,治疗失败率较高.
结论：DBV已显示可有效治疗OA感染。在接受三剂DBV并在抗生素治疗之前进行适当的手术管理的患者中发现了最有利的结果。尽管不存在严格的管理时间表，DBV是治疗OA感染的可行选择。
