复杂患者人群中侵袭性革兰阳性感染的治疗具有挑战性。Dalbavancin,批准用于皮肤和软组织感染,由于其长的半衰期和不频繁的给药,在这种情况下提供了优势。然而,关于超标签达巴万宁对深层感染的结果知之甚少。
■本研究的目的是研究复杂革兰阳性感染患者接受达巴万星治疗作为标准门诊肠胃外抗菌治疗(OPAT)替代治疗的可行性和结局。
■我们进行了多中心,回顾性回顾了在OPAT计划中接受静脉注射达巴万星治疗的成年患者的标示外适应症。如果成年患者在2020年1月至2023年6月之间有治疗细节和随访记录,则包括在内。捕获了dalbavancin使用的详细信息,包括处方适应症。感兴趣的结果包括90天感染复发,假体保留率,90天死亡率,和不良药物事件。
■总之,61名患者接受了达巴万宁,主要是序贯疗法。23%的人在门诊严格接受达巴万金治疗。Dalbavancin主要用于硬件(断裂,脊柱,或接头),天然骨或关节,和复杂的软组织感染。主要病原菌为金黄色葡萄球菌(61%)。由于持续感染(23%),Dalbavancin经常被规定为两剂1500mg方案(49%),线路接入困难(30%),难以达到治疗性万古霉素水平(18%),或药物滥用史(18%)。总的来说,6例患者(10%)发生感染复发,随访期间无患者死亡.硬件保留的8例患者中有3例感染复发。副作用很小,大多是自限性的。
■Dalbavancin是标准OPAT的有效且安全的替代品,尤其是那些对传统的长期静脉注射抗生素有障碍的人。改进的结果可以通过硬件移除来实现。Dalbavancin可以促进早期出院或预防住院。需要对标准OPAT方案与达巴万星方案进行比较研究。
UNASSIGNED: Treatment of invasive gram-positive infections in complex patient populations is challenging. Dalbavancin, approved for skin and soft tissue infections, offers advantages in this setting due to its long half-life and infrequent dosing. However, less is known about the outcomes of off-label dalbavancin for deeper infections.
UNASSIGNED: The objective of this study is to examine the feasibility and outcomes of patients with complex gram-positive infections treated with dalbavancin as an alternative to standard outpatient parenteral antimicrobial therapy (
OPAT).
UNASSIGNED: We conducted a multicenter, retrospective review of adult patients managed within an
OPAT program with intravenous dalbavancin for off-label indications. Adult patients were included if they had treatment details and follow-up documented between January 2020 and June 2023. Details of dalbavancin use including indications for prescription were captured. Outcomes of interest included 90-day infection recurrence, prosthesis retention rates, 90-day mortality, and adverse medication events.
UNASSIGNED: In all, 61 patients received dalbavancin, mostly as sequential therapy. Twenty-three percent received dalbavancin strictly in the outpatient setting. Dalbavancin was used primarily for hardware (fracture, spine, or joint), native bone or joint, and complicated soft tissue infections. The predominant pathogen was Staphylococcus aureus (61%). Dalbavancin was frequently prescribed as a two-dose 1500 mg regimen (49%) due to persistent infection (23%), difficult line access (30%), difficulty achieving therapeutic vancomycin levels (18%), or substance abuse history (18%). Overall, six patients (10%) had infection recurrence and no patients died during the follow-up period. Three of eight patients with hardware retention had infection recurrence. Adverse effects were minimal and mostly self-limiting.
UNASSIGNED: Dalbavancin is an efficacious and safe alternative to standard
OPAT, especially in those with barriers to traditional long-term intravenous antibiotics. Improved outcomes may be achieved with hardware removal. Dalbavancin may facilitate early discharge or prevent hospitalizations. Comparative studies of standard
OPAT regimens versus dalbavancin are needed.