目标:达巴万辛,2014年批准用于革兰氏阳性急性细菌性皮肤和皮肤结构感染(ABSSSI),具有药代动力学,使一个或两个剂量的治疗。Dalbavancin可能在深部感染的门诊肠胃外抗生素治疗(OPAT)中有用,否则需要住院。我们记录了我们在务实的达尔巴万辛使用方面的经验,以评估其对各种适应症的有效性,标签上和标签外,作为主要或序贯巩固治疗。
方法:2021年12月1日至2022年10月1日期间服用达巴万辛的患者进行了年龄人口统计筛查,性别,Charlson合并症指数(CCI),过敏,病原体,dalbavancin的剂量,其他抗生素和手术。如有,记录感染标志物。主要结果是治疗结束时治愈。次要结果包括任何不良事件以及治疗失败的患者,对抢救抗生素的反应。
结果:67%的患者治愈。ABSSSI的适应症治愈率为93%,100%用于菌血症,90%为急性骨髓炎,0%为慢性骨髓炎,75%为天然关节化脓性关节炎,33%为假体关节感染。大多数未治愈的骨和关节感染没有源控制,治疗的目标是抑制。慢性骨髓炎的成功抑制率为48%,人工关节感染的成功抑制率为66%。102例患者中有14例发生不良事件。
结论:本报告增加了达巴万星用于标示外适应症的临床经验,同时进一步验证了其在ABSSSI中的作用。Dalbavancin作为深层感染的主要治疗方法值得在正式的临床试验中进行研究。
OBJECTIVE: Dalbavancin, approved in 2014 for Gram-positive acute bacterial skin and skin structure infections (ABSSSI), has pharmacokinetics enabling treatment with one or two doses. Dalbavancin might be useful in outpatient parenteral antibiotic therapy (OPAT) of deep-seated infections, otherwise requiring inpatient admission. We documented our experience with pragmatic dalbavancin use to assess its effectiveness for varied indications, on- and off-label, as primary or sequential consolidation therapy.
METHODS: Patients prescribed dalbavancin between 1 December 2021 and 1 October 2022 were screened for demographics of age, sex, Charlson comorbidity index (CCI), allergies, pathogens, doses of dalbavancin, other antibiotics administered and surgery. Where available, infection markers were recorded. The primary outcome was a cure at the end of treatment. Secondary outcomes included any adverse events and for those with treatment failures, response to salvage antibiotics.
RESULTS: Sixty-seven per cent of patients were cured. Cure rates by indication were 93% for ABSSSI, 100% for bacteraemia, 90% for acute osteomyelitis, 0% for chronic osteomyelitis, 75% for native joint septic arthritis and 33% for prosthetic joint infection. Most bone and joint infections that were not cured did not have source control, and the goal of treatment was suppressive. Successful suppression rates were greater at 48% for chronic osteomyelitis and 66% for prosthetic joint infections. Adverse events occurred in 14 of 102 patients.
CONCLUSIONS: This report adds to clinical experience with dalbavancin for off-label indications whilst further validating its role in ABSSSI. Dalbavancin as primary therapy in deep-seated infections merits investigation in formal clinical trials.