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Stewardson AJ, Davis JS, Dunlop AJ, Tong SYC, Matthews GV. How I manage severe bacterial infections in people who inject drugs. Clin Microbiol Infect 2024; 30:877-882. [PMID: 38316359 DOI: 10.1016/j.cmi.2024.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/21/2024] [Accepted: 01/30/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Injecting drug use is a risk factor for severe bacterial infection, but there is limited high-quality evidence to guide clinicians providing care to people who inject drugs. Management can be complicated by mistrust, stigma, and competing patient priorities. OBJECTIVES To review the management of severe infections in people who inject drugs, using an illustrative clinical scenario of complicated Staphylococcus aureus bloodstream infection. SOURCES The discussion is based on recent literature searches of relevant topics. Very few randomized clinical trials have focussed specifically on the management of severe bacterial infections among people who inject drugs. Most recommendations are, therefore, based on observational studies, extrapolation from other patient groups, and the experience and opinions of the authors. CONTENT We discuss evidence and options regarding the following management issues for severe bacterial infections among people who inject drugs: initial management of sepsis; indications for surgical management; assessment and management of substance dependence; approaches to antibiotic administration following clinical stability; opportunistic health promotion; and secondary prevention of bacterial infections. Throughout, we highlight the importance of harm reduction and strategies to optimize patient engagement in care through a patient-centred approach. IMPLICATIONS We advocate for a multi-disciplinary trauma-informed approach to the management of severe bacterial infection among people who inject drugs. We emphasize the need for pragmatic trials to inform management guidelines, including those that are co-designed with the community. In particular, research is needed to establish the comparative effectiveness, safety, and cost-effectiveness of inpatient intravenous antibiotics vs. early oral antibiotic switch, outpatient parenteral therapy, and long-acting lipoglycopeptide antibiotics in this scenario.
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Affiliation(s)
- Andrew J Stewardson
- Department of Infectious Diseases, The Alfred and Central Clinical School, Monash University, Melbourne, VIC, Australia.
| | - Joshua S Davis
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia; Infection Research Program, Hunter Medical Research Institute, Newcastle, NSW, Australia; Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Adrian J Dunlop
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia; NSW Drug and Alcohol Clinical Research and Improvement Network, Sydney, NSW, Australia; Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia; Hunter Medical Research Institute, The University of Newcastle, Newcastle, NSW, Australia
| | - Steven Y C Tong
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia; Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Gail V Matthews
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia; St Vincent's Hospital, Sydney, NSW, Australia
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Wolie ZT, Roberts JA, Gilchrist M, McCarthy K, Sime FB. Current practices and challenges of outpatient parenteral antimicrobial therapy: a narrative review. J Antimicrob Chemother 2024:dkae177. [PMID: 38842523 DOI: 10.1093/jac/dkae177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024] Open
Abstract
Extended hospitalization for infection management increases inpatient care costs and the risk of healthcare-associated adverse events, including infections. The growing global demand for healthcare, the diminishing availability of hospital beds and an increasing patient preference for care within their own home have been the primary drivers of the expansion of hospital-in-the-home programmes. Such programmes include the use of IV antimicrobials in outpatient settings, known as outpatient parenteral antimicrobial therapy (OPAT). However, OPAT practices vary globally. This review article aims to describe the current OPAT practices and challenges worldwide. OPAT practice begins with patient evaluation and selection using eligibility criteria, which requires collaboration between the interdisciplinary OPAT team, patients and caregivers. Depending on care requirements, eligible patients may be enrolled to various models of care, receiving medication by healthcare professionals at outpatient infusion centres, hospital clinics, home visits or through self-administration. OPAT can be used for the management of many infections where an effective oral treatment option is lacking. Various classes of parenteral antimicrobials, including β-lactams, aminoglycosides, glycopeptides, fluoroquinolones and antifungals such as echinocandins, are used globally in OPAT practice. Despite its benefits, OPAT has numerous challenges, including complications from medication administration devices, antimicrobial side effects, monitoring requirements, antimicrobial instability, patient non-adherence, patient OPAT rejection, and challenges related to OPAT team structure and administration, all of which impact its outcome. A negative outcome could include unplanned hospital readmission. Future research should focus on mitigating these challenges to enable optimization of the OPAT service and thereby maximize the documented benefits for the healthcare system, patients and healthcare providers.
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Affiliation(s)
- Zenaw T Wolie
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, QLD 4029, Australia
| | - Jason A Roberts
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, QLD 4029, Australia
- Herston Infectious Diseases Institute (HeIDI), Metro North Health, Brisbane, Queensland, Australia
- Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD 4029, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, 30029 Nîmes, France
| | - Mark Gilchrist
- Department of Pharmacy/Infection, Imperial College Healthcare NHS Trust, London, UK
- Department of Infectious Diseases, Imperial College, London, UK
| | - Kate McCarthy
- Royal Brisbane Clinical School, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Fekade B Sime
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, QLD 4029, Australia
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3
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Volk CF, Hutson PR, Rose WE. Simulated Target Attainment of Multidose Regimens of Dalbavancin for Prolonged Durations of Therapy. Open Forum Infect Dis 2024; 11:ofae315. [PMID: 38938895 PMCID: PMC11210303 DOI: 10.1093/ofid/ofae315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 06/04/2024] [Indexed: 06/29/2024] Open
Abstract
Background Dalbavancin is a long-acting lipoglycopeptide antibiotic that is increasingly utilized for infections that require prolonged treatment durations despite the lack of Food and Drug Administration approval for these indications. There is no consensus regarding optimal dosing of dalbavancin for these infections and no available pharmacokinetic studies to identify optimal dosing for long-term use. Methods An in silico pharmacokinetic simulation was performed to assess the predicted dalbavancin concentration resulting from commonly utilized dosing regimens, in addition to modified regimens. The primary endpoint evaluated was days of median 24-hour free area under the curve over the minimum inhibitory concentration (AUC/MIC) >27.1, the established PK target. Results A dosing regimen of 1500 mg on day 0 and day 7 resulted in median AUC/breakpoint value above the target for 57 days (lower 95% confidence interval [CI], 37 days). A modified regimen of 1500 mg on day 0 and day 21 resulted in an additional 11 days of median AUC/breakpoint target attainment. The other standard dosing regimen modeled was 1000 mg on day 0, then 500 mg weekly for 5 doses. This regimen achieved the AUC/breakpoint target for 76 days (lower 95% CI, 59 days). This regimen was modified to 1000 mg on day 0, then 500 mg on days 14 and 28, which shortened the median effective treatment duration by 14 days but required 3 fewer doses. Conclusions These simulated results, when combined with the favorable observational data, support the use of commonly reported dalbavancin regimens for prolonged therapy durations. In addition, these pharmacokinetic/pharmacodynamic data support extending the dosing interval beyond the frequently reported weekly regimens, which should be investigated further with a clinical trial.
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Affiliation(s)
- Cecilia F Volk
- Pharmacy Practice and Translational Research Division, School of Pharmacy, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Paul R Hutson
- Pharmacy Practice and Translational Research Division, School of Pharmacy, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Warren E Rose
- Pharmacy Practice and Translational Research Division, School of Pharmacy, University of Wisconsin–Madison, Madison, Wisconsin, USA
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Bresges C, Bresges K, Hewitt C, Sharma S, Davies B. Three-years of dalbavancin use at a UK tertiary referral hospital serving a population with high numbers of people who inject drugs. JAC Antimicrob Resist 2024; 6:dlae066. [PMID: 38716401 PMCID: PMC11073745 DOI: 10.1093/jacamr/dlae066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 04/04/2024] [Indexed: 06/29/2024] Open
Abstract
Background Dalbavancin's unique properties have led to an increase in its off-licence use in complex infection and in vulnerable populations including people who inject drugs (PWID), but data remain limited. In this retrospective cohort study, we describe the characteristics, treatment rationale and outcomes for all adult inpatients treated with dalbavancin at a UK tertiary hospital. Results Fifty-eight inpatients were treated with dalbavancin between 1 January 2018 and 1 January 2021, 98.3% for off-licence diagnoses. Acute bacterial skin and skin structure infection, infective endocarditis and endovascular infections were each diagnosed in 22.4% of patients. Bone and joint infections were diagnosed in 18.9%, discitis in 12.1% and central line-associated bloodstream infections in 5.2%. Sixty-nine percent of patients were bacteraemic; 52.5% Staphylococcus aureus, 5.0% MRSA. Two mild adverse reactions were attributed to dalbavancin. Treatment was successful in 43 (75.4%) patients, and failed in seven (12.3%). Seven (12.3%) were lost to follow-up.Thirty-five patients (60.3%) were PWID, with low median age (41.0 years) and Charlson Comorbidity scores (0). Self-discharge was taken by 17.1% of PWID, and 20.6% were lost to follow-up. At 90 days, three (8.6%) PWID were deceased. Conclusions In this first UK cohort, dalbavancin was used off licence and in persons facing barriers to conventional therapies. Where data is available, it was safe and effective. Dalbavancin appears a potentially valuable tool in improving outcomes for PWID.
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Affiliation(s)
- Carolin Bresges
- Brighton and Sussex Medical School Department of Global Health and Infection, University of Sussex, 94 N–S Road, Falmer, Brighton BN1 9PX, UK
- The Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Eastern Road, Brighton BN2 5BE, UK
| | - Kristina Bresges
- Department of Anaesthetics, King’s College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
| | - Claudette Hewitt
- The Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Eastern Road, Brighton BN2 5BE, UK
| | - Sunil Sharma
- The Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Eastern Road, Brighton BN2 5BE, UK
| | - Bethany Davies
- Brighton and Sussex Medical School Department of Global Health and Infection, University of Sussex, 94 N–S Road, Falmer, Brighton BN1 9PX, UK
- The Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Eastern Road, Brighton BN2 5BE, UK
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Donnelly D, Pillinger KE, Debnath A, DePasquale W, Munsiff S, Louie T, Jones CMC, Shulder S. Cost evaluation of continuation of therapy with dalbavancin compared to standard-of-care antibiotics alone in hospitalized persons who inject drugs with severe gram-positive infections. Am J Health Syst Pharm 2024; 81:S40-S48. [PMID: 38465838 DOI: 10.1093/ajhp/zxae025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Indexed: 03/12/2024] Open
Abstract
PURPOSE Persons who inject drugs (PWID) are at risk for severe gram-positive infections and may require prolonged hospitalization and intravenous (IV) antibiotic therapy. Dalbavancin (DBV) is a long-acting lipoglycopeptide that may reduce costs and provide effective treatment in this population. METHODS This was a retrospective review of PWID with severe gram-positive infections. Patients admitted from January 1, 2017, to November 1, 2019 (standard-of-care [SOC] group) and from November 15, 2019, to March 31, 2022 (DBV group) were included. The primary outcome was the total cost to the healthcare system. Secondary outcomes included hospital days saved and treatment failure. RESULTS A total of 87 patients were included (37 in the DBV group and 50 in the SOC group). Patients were a median of 34 years old and were predominantly Caucasian (82%). Staphylococcus aureus (82%) was the most common organism, and bacteremia (71%) was the most common type of infection. Compared to the SOC group, the DBV group would have had a median of 14 additional days of hospitalization if they had stayed to complete their therapy (P = 0.014). The median total cost to the healthcare system was significantly lower in the DBV group than in the SOC group ($31,698.00 vs $45,093.50; P = 0.035). The rate of treatment failure was similar between the groups (32.4% in the DBV group vs 36% in the SOC group; P = 0.729). CONCLUSION DBV is a cost-saving alternative to SOC IV antibiotics for severe gram-positive infections in PWID, with similar treatment outcomes. Larger prospective studies, including other patient populations, may demonstrate additional benefit.
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Affiliation(s)
- Devin Donnelly
- Department of Pharmacy, University of Rochester Medical Center: Strong Memorial Hospital, Rochester, NY, USA
| | | | | | - William DePasquale
- Department of Pharmacy, University of Rochester Medical Center: Highland Hospital, Rochester, NY, USA
| | - Sonal Munsiff
- Division of Infectious Diseases, University of Rochester Medical Center: Strong Memorial Hospital, Rochester, NY, USA
| | - Ted Louie
- Division of Infectious Diseases, University of Rochester Medical Center: Strong Memorial Hospital, Rochester, NY, USA
| | - Courtney Marie Cora Jones
- Department of Emergency Medicine, University of Rochester Medical Center: Strong Memorial Hospital, Rochester, NY, USA
| | - Stephanie Shulder
- Department of Pharmacy, University of Rochester Medical Center: Strong Memorial Hospital, Rochester, NY, USA
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Wurcel AG, Suzuki J, Schranz AJ, Eaton EF, Cortes-Penfield N, Baddour LM. Strategies to Improve Patient-Centered Care for Drug Use-Associated Infective Endocarditis: JACC Focus Seminar 2/4. J Am Coll Cardiol 2024; 83:1338-1347. [PMID: 38569764 DOI: 10.1016/j.jacc.2024.01.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 04/05/2024]
Abstract
Drug use-associated infective endocarditis (DUA-IE) is a major cause of illness and death for people with substance use disorder (SUD). Investigations to date have largely focused on advancing the care of patients with DUA-IE and included drug use disorder treatment, decisions about surgery, and choice of antibiotics during the period of hospitalization. Transitions from hospital to outpatient care are relatively unstudied and frequently a key factor of uncontrolled infection, continued substance use, and death. In this paper, we review the evidence supporting cross-disciplinary care for people with DUA-IE and highlight domains that need further clinician, institutional, and research investment in clinicians and institutions. We highlight best practices for treating people with DUA-IE, with a focus on addressing health disparities, meeting health-related social needs, and policy changes that can support care for people with DUA-IE in the hospital and when transitioning to the community.
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Affiliation(s)
- Alysse G Wurcel
- Department of Medicine, Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, USA.
| | - Joji Suzuki
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Asher J Schranz
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Ellen F Eaton
- Department of Medicine, University of Alabama, Birmingham, Alabama, USA
| | | | - Larry M Baddour
- Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
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7
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McSorley JC, Reyes D, Tonna I, Bateman V. Experience with dalbavancin use in various gram-positive infections within Aberdeen Royal Infirmary OPAT service. Infection 2024; 52:567-576. [PMID: 38165594 PMCID: PMC10954975 DOI: 10.1007/s15010-023-02152-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/27/2023] [Indexed: 01/04/2024]
Abstract
PURPOSE 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. CONCLUSION 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.
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Affiliation(s)
- James C McSorley
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Darshini Reyes
- Department of Pharmacy, NHS Grampian, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Ivan Tonna
- Infection Unit, NHS Grampian, Aberdeen Royal Infirmary, Aberdeen, UK.
| | - Vhairi Bateman
- Infection Unit, NHS Grampian, Aberdeen Royal Infirmary, Aberdeen, UK
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Zambrano S, Paras ML, Suzuki J, Pearson JC, Dionne B, Schrager H, Mallada J, Szpak V, Fairbank-Haynes K, Kalter M, Prostko S, Solomon DA. Real-World Dalbavancin Use for Serious Gram-Positive Infections: Comparing Outcomes Between People Who Use and Do Not Use Drugs. Open Forum Infect Dis 2024; 11:ofae186. [PMID: 38651139 PMCID: PMC11034951 DOI: 10.1093/ofid/ofae186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/03/2024] [Indexed: 04/25/2024] Open
Abstract
Background Dalbavancin has been used off-label to treat invasive bacterial infections in vulnerable populations like people who use drugs (PWUD) because of its broad gram-positive coverage and unique pharmacological properties. This retrospective, multisite study examined clinical outcomes at 90 days in PWUD versus non-PWUD after secondary treatment with dalbavancin for bacteremia, endocarditis, osteomyelitis, septic arthritis, and epidural abscesses. Methods Patients at 3 teaching hospitals who received dalbavancin for an invasive infection between March 2016 and May 2022 were included. Characteristics of PWUD and non-PWUD, infection highlights, hospital stay and treatment, and outcomes were compared using χ2 for categorical variables, t test for continuous variables, and nonparametric tests where appropriate. Results There were a total of 176 patients; 78 were PWUD and 98 were non-PWUD. PWUD were more likely to have a patient-directed discharge (26.9% vs 3.1%; P < .001) and be lost to follow-up (20.5% vs 7.14%; P < .01). Assuming loss to follow-up did not achieve clinical cure, 73.1% of PWUD and 74.5% of non-PWUD achieved clinical cure at 90 days (P = .08). Conclusions Dalbavancin was an effective treatment option for invasive gram-positive infections in our patient population. Despite higher rates of patient-directed discharge and loss to follow-up, PWUD had similar rates of clinical cure at 90 days compared to non-PWUD.
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Affiliation(s)
- Sarah Zambrano
- Brigham and Women’s Hospital, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Molly L Paras
- Massachusetts General Hospital, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Joji Suzuki
- Brigham and Women’s Hospital, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeffrey C Pearson
- Brigham and Women’s Hospital, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Brandon Dionne
- Brigham and Women’s Hospital, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Harry Schrager
- Newton Wellesley Hospital, Department of Medicine, Boston, Massachusetts, USA
| | - Jason Mallada
- Newton Wellesley Hospital, Department of Medicine, Boston, Massachusetts, USA
| | - Veronica Szpak
- Brigham and Women’s Hospital, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Marlene Kalter
- Newton Wellesley Hospital, Department of Medicine, Boston, Massachusetts, USA
| | - Sara Prostko
- Brigham and Women’s Hospital, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel A Solomon
- Brigham and Women’s Hospital, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Morata Ruiz L, Ruggieri A, Falcone M, Pasquau Liaño J, Gentile I, Salavert Lletí M, Moreno Núñez L, Cascio A, Tascini C, Loeches Yagüe M, De Rosa FG, Ori A, Comandini A, Cattaneo A, Grossi PA. Dalbavancin real-life utilization among diabetic patients suffering from infections in Italy and Spain: The DALBADIA retrospective cohort study. J Glob Antimicrob Resist 2024; 36:200-209. [PMID: 38211660 DOI: 10.1016/j.jgar.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 11/14/2023] [Accepted: 11/29/2023] [Indexed: 01/13/2024] Open
Abstract
OBJECTIVES To retrospectively describe the patterns of use of dalbavancin for treating infections in diabetic patients in Italian and Spanish standard clinical practice. METHODS DALBADIA [NCT04959799] was a multicentre, observational, retrospective cohort study, conducted in Italy and Spain. The study enrolled 97 adults with type 1 or 2 diabetes mellitus, treated with dalbavancin as per standard clinical practice for a Gram-positive bacterial infection or the Gram-positive component of a mixed infection. RESULTS Dalbavancin was used to treat cellulitis (18/92 patients, 19.6%), followed by prosthetic joint infection (14 patients, 15.2%), endocarditis (13 patients, 14.1%), and primary bacteraemia (10 patients, 10.9%); 78/92 (84.8%) patients had Gram-positive infections only, and 14 (15.2%) had mixed infections. The most frequently isolated microorganisms were Staphylococcus aureus in 43 (55.8% of the patients with microbial isolation), 25.6% of which methicillin-resistant; Staphylococcus epidermidis in 13 (16.9%), 53.8% of which methicillin-resistant; Enterococcus faecalis in 11 (14.3%). The main reason for the dalbavancin choice was the intent to simplify the antibiotic regimen (81.5% of cases). A multidisciplinary team participated in the treatment choice process for 53 (57.6%) patients. Dalbavancin was given as first-line antibiotic in 34 (37.0%) patients and administered as one infusion in 32 (34.8%), and as two infusions in 39 (42.4%). In total, 57/62 (91.9%) eligible patients with available assessment were judged clinically cured or improved at the end of observation. CONCLUSION In clinical practice, dalbavancin was used in diabetic patients to treat ABSSSIs and other difficult-to-treat infections with a favourable safety profile and a high rate of positive clinical responses.
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Affiliation(s)
- Laura Morata Ruiz
- Hospital Clìnic, Department of Infectious Diseases, University of Barcelona, Barcelona, Spain
| | | | - Marco Falcone
- AOU Pisana PO Cisanello, UO Malattie Infettive, University of Pisa, Pisa, Italy
| | - Juan Pasquau Liaño
- Hospital Universitario Virgen de las Nieve, Unidad de Enfermedades Infecciosas, Granada, Spain
| | - Ivan Gentile
- AOU Federico II, Malattie Infettive, Patologia Clinica e Medicina Interna, Università di Napoli Federico II, Naples, Italy
| | - Miguel Salavert Lletí
- Hospital Universitario y Politécnico La Fe, Unidad de Enfermedades Infecciosas, Valencia, Spain
| | - Leonor Moreno Núñez
- Hospital Universitario Fundación Alcorcón, Enfermedades Infecciosas, Madrid, Spain
| | - Antonio Cascio
- AOU Policlinico Giaccone, UOC Malattie Infettive e Tropicali, Palermo, Italy
| | | | | | - Francesco Giuseppe De Rosa
- Ospedale Cardinal Massaia, SC Malattie Infettive, Asti, Italy, AOU Città della Salute e Scienza, Presidio Molinette, Turin, Italy
| | | | | | | | - Paolo Antonio Grossi
- ASST Sette Laghi, SC Malattie Infettive e Tropicali, University of Insubria, Varese, Italy
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Streifel AC, Strnad LC, Sikka MK, Varley CD, Makadia J, Sukerman E, Douglass AH, Mayer H, Young K, Lewis JS. Dalba Got Back? Use of Dalbavancin for the Treatment of Vertebral Osteomyelitis. Open Forum Infect Dis 2024; 11:ofae070. [PMID: 38449918 PMCID: PMC10917187 DOI: 10.1093/ofid/ofae070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Indexed: 03/08/2024] Open
Abstract
Data evaluating dalbavancin use for vertebral osteomyelitis remain limited. In our retrospective cohort, 29 of 34 (85.3%) patients completed their dalbavancin course. Adverse reactions occurred for 6 (17.6%) and infection recurrence in 3 (8.8%) within 90 days. Dalbavancin appears to be safe and well-tolerated for vertebral osteomyelitis.
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Affiliation(s)
- Amber C Streifel
- Department of Pharmacy, Oregon Health & Science University, Portland, Oregon, USA
| | - Luke C Strnad
- Department of Medicine, Division of Infectious Diseases, Oregon Health & Science University, Portland, Oregon, USA
- School of Public Health, Epidemiology Programs, Oregon Health & Science University and Portland State University, Portland, Oregon, USA
| | - Monica K Sikka
- Department of Medicine, Division of Infectious Diseases, Oregon Health & Science University, Portland, Oregon, USA
| | - Cara D Varley
- Department of Medicine, Division of Infectious Diseases, Oregon Health & Science University, Portland, Oregon, USA
- School of Public Health, Epidemiology Programs, Oregon Health & Science University and Portland State University, Portland, Oregon, USA
| | - Jina Makadia
- Department of Medicine, Division of Infectious Diseases, Oregon Health & Science University, Portland, Oregon, USA
| | - Ellie Sukerman
- Department of Medicine, Division of Infectious Diseases, Oregon Health & Science University, Portland, Oregon, USA
| | - Alyse H Douglass
- Department of Medicine, Division of Infectious Diseases, Oregon Health & Science University, Portland, Oregon, USA
| | - Heather Mayer
- Department of Medicine, Division of Infectious Diseases, Oregon Health & Science University, Portland, Oregon, USA
| | - Kathleen Young
- Department of Medicine, Division of Infectious Diseases, Oregon Health & Science University, Portland, Oregon, USA
| | - James S Lewis
- Department of Pharmacy, Oregon Health & Science University, Portland, Oregon, USA
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11
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Bao H, Igwilo-Alaneme R, Sonia F, Cowman K, Kahn M, Nori P. Dalbavancin as an alternative to traditional outpatient parenteral antimicrobial therapy for deep gram-positive infections - an observational, retrospective review. Ther Adv Infect Dis 2024; 11:20499361241245523. [PMID: 38645297 PMCID: PMC11032056 DOI: 10.1177/20499361241245523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 03/20/2024] [Indexed: 04/23/2024] Open
Abstract
Background 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. Objectives 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). Methods 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. Results 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. Conclusion 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.
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Affiliation(s)
- Hongkai Bao
- Department of Pharmacy, Montefiore Medical Center, Albert Einstein College of Medicine, 600 East 233 Street, Bronx, NY 10466, USA
| | - Rita Igwilo-Alaneme
- Department of Medicine, Montefiore Wakefield Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Fnu Sonia
- Department of Medicine, Montefiore Wakefield Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kelsie Cowman
- Department of Medicine, Division of Infectious Diseases, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
- Network Performance Group, Montefiore Health System, Bronx, NY, USA
| | - Mani Kahn
- Department of Orthopedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Priya Nori
- Department of Medicine, Division of Infectious Diseases, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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12
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Oliva A, Cogliati Dezza F, Cancelli F, Curtolo A, Falletta A, Volpicelli L, Venditti M. New Antimicrobials and New Therapy Strategies for Endocarditis: Weapons That Should Be Defended. J Clin Med 2023; 12:7693. [PMID: 38137762 PMCID: PMC10743892 DOI: 10.3390/jcm12247693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/22/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
The overall low-quality evidence concerning the clinical benefits of different antibiotic regimens for the treatment of infective endocarditis (IE), which has made it difficult to strongly support or reject any regimen of antibiotic therapy, has led to a discrepancy between the available guidelines and clinical practice. In this complex scenario, very recently published guidelines have attempted to fill this gap. Indeed, in recent years several antimicrobials have entered the market, including ceftobiprole, ceftaroline, and the long-acting lipoglycopeptides dalbavancin and oritavancin. Despite being approved for different indications, real-world data on their use for the treatment of IE, alone or in combination, has accumulated over time. Furthermore, an old antibiotic, fosfomycin, has gained renewed interest for the treatment of complicated infections such as IE. In this narrative review, we focused on new antimicrobials and therapeutic strategies that we believe may provide important contributions to the advancement of Gram-positive IE treatment, providing a summary of the current in vitro, in vivo, and clinical evidence supporting their use in clinical practice.
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Affiliation(s)
- Alessandra Oliva
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (F.C.D.); (F.C.); (A.C.); (A.F.); (L.V.); (M.V.)
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13
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Bork JT, Heil EL. What Is Left to Tackle in Inpatient Antimicrobial Stewardship Practice and Research. Infect Dis Clin North Am 2023; 37:901-915. [PMID: 37586930 DOI: 10.1016/j.idc.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Despite widespread uptake of antimicrobial stewardship in acute care hospitals, there is ongoing need for innovation and optimization of ASPs. This article discusses current antimicrobial stewardship practice challenges and ways to improve current antimicrobial stewardship workflows. Additionally, we propose new workflows that further engage front line clinicians in optimizing their own antibiotic decision making.
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Affiliation(s)
- Jacqueline T Bork
- Division of Infectious Diseases, Institute of Human Virology in the Department of Medicine, University of Maryland, School of Medicine, 22 S Greene Street, Baltimore, MD 21201, USA
| | - Emily L Heil
- Department of Practice, Sciences, and Health-Outcomes Research, University of Maryland, School of Pharmacy, 20 N Pine Street, Baltimore, MD 21201, USA.
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14
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Dimopoulou D, Mantadakis E, Koutserimpas C, Samonis G. A Narrative Review on the Role of Dalbavancin in the Treatment of Bone and Joint Infections. Antibiotics (Basel) 2023; 12:1492. [PMID: 37887193 PMCID: PMC10604335 DOI: 10.3390/antibiotics12101492] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/28/2023] Open
Abstract
Bone and joint infections (BJI) require prolonged antimicrobial treatment, leading to lengthy hospitalizations, high costs, the risk of nosocomial infections, and the development of antimicrobial resistance. Dalbavancin is a novel semisynthetic lipoglycopeptide approved for the treatment of adults and children with acute bacterial skin and skin structure infections. This narrative review aims to summarize the characteristics of dalbavancin and the current scientific evidence regarding its clinical efficacy and safety in the treatment of BJI. A literature search until June 2023 was performed to identify all published research about the role of dalbavancin in the management of BJI. Due to its unique pharmacokinetics characterized by prolonged half-life, high bactericidal activity against most Gram-positive bacteria, a good safety profile, and high tissue penetration, dalbavancin can be a valuable alternative to the treatment of BJI. Clinical studies have shown its non-inferiority compared to conventional therapies in BJI, offering potent activity against key pathogens and an extended dosing interval that may shorten hospitalization. In conclusion, dalbavancin represents a promising treatment option for BJI with a favorable safety profile, but further research in both adults and particularly children, who are ideal candidates for long-acting antibiotics, is necessary to evaluate the role of dalbavancin in BJI.
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Affiliation(s)
- Dimitra Dimopoulou
- Second Department of Pediatrics, “Aghia Sophia” Children’s Hospital, 115 27 Athens, Greece;
| | - Elpis Mantadakis
- Department of Pediatrics, University General Hospital of Alexandroupolis, 681 00 Alexandroupolis, Greece;
| | - Christos Koutserimpas
- Department of Orthopaedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, 115 25 Athens, Greece;
| | - George Samonis
- Department of Medicine, University of Crete, 715 00 Heraklion, Greece
- First Department of Medical Oncology, “Metropolitan” Hospital, 185 47 Attica, Greece
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15
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Ioannou P, Wolff N, Mathioudaki A, Spanias C, Spernovasilis N, Kofteridis DP. Real-World Data Regarding Dalbavancin Use before and during the COVID-19 Pandemic-A Single-Center Retrospective Study. Antibiotics (Basel) 2023; 12:1205. [PMID: 37508301 PMCID: PMC10376731 DOI: 10.3390/antibiotics12071205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/15/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
Dalbavancin is a semisynthetic lipoglycopeptide, which possesses great potential for bactericidal activity similar to antimicrobials with the same mechanism of action, such as vancomycin and teicoplanin. Due to its very prolonged half-life, it can be used in a single or two-dose regimen to treat infections by Gram-positive microorganisms, even resistant ones, such as methicillin-resistant Staphylococcus aureus (MRSA). Currently, it is approved only for the treatment of acute bacterial skin and skin structure infections (ABSSSIs). The aim of this study was to investigate the clinical and microbiological characteristics of patients to whom dalbavancin was administered at the University Hospital of Heraklion and evaluate its use in regard to the COVID-19 pandemic. In total, 146 patients were included in this retrospective cohort study evaluating the use of dalbavancin from the first time it was used in 2017 until the end of 2022. The median age was 68 years (range: 21-96 years), and 86 (59%) patients were male. The most common indications for dalbavancin use were osteoarticular infections in 43%, followed by ABSSSIs in 37%, and cardiovascular infections in 10%. Dalbavancin was used empirically in one out of three patients, most commonly with the indication of ABSSSIs, and most commonly in the post-COVID-19 era. The most frequently isolated pathogens were coagulase-negative staphylococci in 70%, S. aureus in 27%, Enterococcus spp. in 22%, and Streptococcus spp. in 8%, while one out of three infections were polymicrobial. In 12% of patients, the infection was not cured, but no patients died. For patients with ABSSSIs, endocarditis and vascular infections, and bacteremia, the cure rates were more than 90%, and in osteoarticular infections, the cure rate was 76%. Thus, dalbavancin has great potential for use in complicated and invasive infections that may require prolonged intravenous antimicrobial treatment. However, further studies are required to formally investigate its role in such infections.
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Affiliation(s)
- Petros Ioannou
- School of Medicine, University of Crete, 71003 Heraklion, Greece
- Internal Medicine Department, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Nora Wolff
- School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Anna Mathioudaki
- Internal Medicine Department, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Christos Spanias
- Department of Pharmacy, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Nikolaos Spernovasilis
- School of Medicine, University of Crete, 71003 Heraklion, Greece
- German Oncology Center, Limassol 4108, Cyprus
| | - Diamantis P Kofteridis
- School of Medicine, University of Crete, 71003 Heraklion, Greece
- Internal Medicine Department, University Hospital of Heraklion, 71110 Heraklion, Greece
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16
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Lovatti S, Tiecco G, Mulé A, Rossi L, Sforza A, Salvi M, Signorini L, Castelli F, Quiros-Roldan E. Dalbavancin in Bone and Joint Infections: A Systematic Review. Pharmaceuticals (Basel) 2023; 16:1005. [PMID: 37513919 PMCID: PMC10385685 DOI: 10.3390/ph16071005] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/09/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
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.
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Affiliation(s)
- Sofia Lovatti
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Giorgio Tiecco
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Alice Mulé
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Luca Rossi
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Anita Sforza
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Martina Salvi
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Liana Signorini
- Unit of Infectious and Tropical Diseases, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Francesco Castelli
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Eugenia Quiros-Roldan
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, Italy
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17
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Chang J, Tasellari A, Wagner JL, Scheetz MH. Contemporary pharmacologic treatments of MRSA for hospitalized adults: rationale for vancomycin versus non-vancomycin therapies as first line agents. Expert Rev Anti Infect Ther 2023; 21:1309-1325. [PMID: 37876291 DOI: 10.1080/14787210.2023.2275663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 10/23/2023] [Indexed: 10/26/2023]
Abstract
INTRODUCTION Methicillin-resistant Staphylococcus aureus (MRSA) remains an important pathogen in the hospital setting and causes significant morbidity and mortality each year. Since the initial discovery over 60 years ago, vancomycin has remained a first-line treatment for many different types of MRSA infections. However, significant concerns related to target attainment and nephrotoxicity have spurred efforts to develop more effective agents in the last two decades. AREAS COVERED Newer anti-MRSA antibiotics that have been approved since 2000 include linezolid, daptomycin, and ceftaroline. As clinical evidence has accumulated, these newer agents have become more frequently used, and some are now recommended as co-first-line options (along with vancomycin) in clinical practice guidelines. For this review, a scoping review of the literature was conducted to support our findings and recommendations. EXPERT OPINION Vancomycin remains an important standard of care for MRSA infections but is limited with respect to nephrotoxicity and rapid target attainment. Newer agents such as linezolid, daptomycin, and ceftaroline have specific indications for treating different types of MRSA infections; however, newer agents also have unique attributes which require consideration during therapy.
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Affiliation(s)
- Jack Chang
- Department of Pharmacy Practice, Midwestern University College of Pharmacy, Downers Grove, IL, USA
- Pharmacometrics Center of Excellence, Midwestern University College of Pharmacy, Downers Grove, IL, USA
- Northwestern Memorial Hospital, Department of Pharmacy, Chicago, IL, USA
| | - Ardita Tasellari
- Department of Pharmacy Practice, Midwestern University College of Pharmacy, Downers Grove, IL, USA
| | - Jamie L Wagner
- School of Pharmacy, University of Mississippi, Jackson, MS, USA
| | - Marc H Scheetz
- Department of Pharmacy Practice, Midwestern University College of Pharmacy, Downers Grove, IL, USA
- Pharmacometrics Center of Excellence, Midwestern University College of Pharmacy, Downers Grove, IL, USA
- Northwestern Memorial Hospital, Department of Pharmacy, Chicago, IL, USA
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18
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Witzany C, Rolff J, Regoes RR, Igler C. The pharmacokinetic-pharmacodynamic modelling framework as a tool to predict drug resistance evolution. MICROBIOLOGY (READING, ENGLAND) 2023; 169:001368. [PMID: 37522891 PMCID: PMC10433423 DOI: 10.1099/mic.0.001368] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/12/2023] [Indexed: 08/01/2023]
Abstract
Pharmacokinetic-pharmacodynamic (PKPD) models, which describe how drug concentrations change over time and how that affects pathogen growth, have proven highly valuable in designing optimal drug treatments aimed at bacterial eradication. However, the fast rise of antimicrobial resistance calls for increased focus on an additional treatment optimization criterion: avoidance of resistance evolution. We demonstrate here how coupling PKPD and population genetics models can be used to determine treatment regimens that minimize the potential for antimicrobial resistance evolution. Importantly, the resulting modelling framework enables the assessment of resistance evolution in response to dynamic selection pressures, including changes in antimicrobial concentration and the emergence of adaptive phenotypes. Using antibiotics and antimicrobial peptides as an example, we discuss the empirical evidence and intuition behind individual model parameters. We further suggest several extensions of this framework that allow a more comprehensive and realistic prediction of bacterial escape from antimicrobials through various phenotypic and genetic mechanisms.
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Affiliation(s)
| | - Jens Rolff
- Evolutionary Biology, Institute for Biology, Freie Universität Berlin, Berlin, Germany
| | - Roland R. Regoes
- Institute of Integrative Biology, ETH Zurich, Zurich, Switzerland
| | - Claudia Igler
- Institute of Integrative Biology, ETH Zurich, Zurich, Switzerland
- School of Biological Sciences, University of Manchester, Manchester, UK
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19
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Attwood LO, Bryant M, Lee SJ, Vujovic O, Higgs P, Doyle JS, Stewardson AJ. Epidemiology and Management of invasive infections among people who Use drugs (EMU): protocol for a prospective, multicentre cohort study. BMJ Open 2023; 13:e070236. [PMID: 37012020 PMCID: PMC10083776 DOI: 10.1136/bmjopen-2022-070236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2023] Open
Abstract
INTRODUCTION People who inject drugs (PWID) are at risk of invasive infections such as bloodstream infections, endocarditis, osteomyelitis and septic arthritis. Such infections require prolonged antibiotic therapy, but there is limited evidence about the optimal care model to deliver to this population. The Epidemiology and Management of invasive infections among people who Use drugs (EMU) study aims to (1) describe the current burden, clinical spectrum, management and outcomes of invasive infections in PWID; (2) determine the impact of currently available models of care on completion of planned antimicrobials for PWID admitted to hospital with invasive infections and (3) determine postdischarge outcomes of PWID admitted with invasive infections at 30 and 90 days. METHODS AND ANALYSIS EMU is a prospective multicentre cohort study of Australian public hospitals who provide care to PWIDs with invasive infections. All patients who have injected drugs in the previous six months and are admitted to a participating site for management of an invasive infection are eligible. EMU has two components: (1) EMU-Audit will collect information from medical records, including demographics, clinical presentation, management and outcomes; (2) EMU-Cohort will augment this with interviews at baseline, 30 and 90 days post-discharge, and data linkage examining readmission rates and mortality. The primary exposure is antimicrobial treatment modality, categorised as inpatient intravenous antimicrobials, outpatient antimicrobial therapy, early oral antibiotics or lipoglycopeptide. The primary outcome is confirmed completion of planned antimicrobials. We aim to recruit 146 participants over a 2-year period. ETHICS AND DISSEMINATION EMU has been approved by the Alfred Hospital Human Research Ethics Committee (Project number 78815.) EMU-Audit will collect non-identifiable data with a waiver of consent. EMU-Cohort will collect identifiable data with informed consent. Findings will be presented at scientific conferences and disseminated by peer-review publications. TRIAL REGISTRATION NUMBER ACTRN12622001173785; Pre-results.
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Affiliation(s)
- Lucy O Attwood
- Department of Infectious Diseases, the Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Mellissa Bryant
- Department of Infectious Diseases, the Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Sue J Lee
- Department of Infectious Diseases, the Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Olga Vujovic
- Department of Infectious Diseases, the Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Peter Higgs
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- Department of Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Joseph S Doyle
- Department of Infectious Diseases, the Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Andrew J Stewardson
- Department of Infectious Diseases, the Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia
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20
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Bai F, Mazzitelli M, Silvola S, Raumer F, Restelli U, Croce D, Marchetti G, Cattelan AM. Cost analysis of dalbavancin versus standard of care for the treatment of acute bacterial skin and skin structure infections (ABSSSIs) in two Italian hospitals. JAC Antimicrob Resist 2023; 5:dlad044. [PMID: 37090914 PMCID: PMC10116602 DOI: 10.1093/jacamr/dlad044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 03/25/2023] [Indexed: 04/25/2023] Open
Abstract
Objectives Thanks to its long half-life, dalbavancin qualifies as an optimal drug for saving costs. We aimed to assess the cost and effectiveness of dalbavancin versus the standard of care (SoC). Patients and methods We conducted a multicentre retrospective study, including all hospitalized or outpatients diagnosed with ABSSSIs at Padua University Hospital, Padua and San Paolo Hospital, Milan (1 January 2016 to 31 July 2020). We compared patients according to antibiotic treatment (dalbavancin versus SoC), the number of lines of dalbavancin treatment, and monotherapy or combination (dalbavancin in association with other antibiotics). Primary endpoints were direct medical costs and length of hospital stay (LOS) associated with ABSSSI management; Student's t-test, chi-squared test and one-way ANOVA were used. Results One hundred and twenty-six of 228 (55.3%) patients received SoC, while 102/228 (44.7%) received dalbavancin. Twenty-seven of the 102 (26.5%) patients received dalbavancin as first-line treatment, 46 (45.1%) as second-line, and 29 (28.4%) as third- or higher-line treatment. Most patients received dalbavancin as monotherapy (62/102; 60.8%). Compared with SoC, dalbavancin was associated with a significant reduction of LOS (5 ± 7.47 days for dalbavancin, 9.2 ± 5.59 days for SoC; P < 0.00001) and with lower mean direct medical costs (3470 ± 2768€ for dalbavancin; 3493 ± 1901€ for SoC; P = 0.9401). LOS was also reduced for first-line dalbavancin, in comparison with second-, third- or higher-line groups, and for dalbavancin monotherapy versus combination therapy. Mean direct medical costs were significantly lower in first-line dalbavancin compared with higher lines, but no cost difference was observed between monotherapy and combination therapy. Conclusions Monotherapy with first-line dalbavancin was confirmed as a promising strategy for ABSSSIs in real-life settings, thanks to its property in reducing LOS and saving direct medical costs.
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Affiliation(s)
| | | | - Sofia Silvola
- Carlo Cattaneo—LIUC University, Castellanza, VA, Italy
- Department of Public Health Medicine, School of Health System & Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | | | - Umberto Restelli
- Carlo Cattaneo—LIUC University, Castellanza, VA, Italy
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Davide Croce
- Carlo Cattaneo—LIUC University, Castellanza, VA, Italy
- Department of Public Health Medicine, School of Health System & Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | | | - Anna Maria Cattelan
- Infectious and Tropical Diseases Unit Department, Padua University Hospital, Padua, Italy
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Valerio M, Veintimilla C, Rodríguez C, de la Villa S, Sánchez-Somolinos M, Cerezales M, Crespo C, Rodríguez S, Adan I, Chamorro E, Rosselló I, Muñoz P. Cost analysis of disease including treatment with dalbavancin in a Spanish hospital: ECODAL ANALYSIS. J Med Econ 2023; 26:463-472. [PMID: 36950932 DOI: 10.1080/13696998.2023.2190704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
INTRODUCTION AND AIM Dalbavancin is an antibiotic with activity against gram-positive bacteria that allows early discharge of patients requiring intravenous therapy. Outpatient treatment helps offset hospitalisation costs associated with standard intravenous treatment. Our objective was to assess the cost of disease management, including treatment with dalbavancin, in a Spanish hospital for 1 year, and the hypothetical costs associated with treatment with other therapeutic alternatives to dalbavancin. METHODS A single-centre, observational, retrospective post-hoc analysis was conducted based on electronic medical records analysing all patients who received dalbavancin treatment for 1 year; cost analysis was performed for the whole process. In addition, three scenarios designed on the basis of real clinical practice by clinical experts were hypothesised: (i) individual therapeutic alternative to dalbavancin, (ii) all patients treated with daptomycin, and (iii) all days of dalbavancin as outpatient treatment transformed into hospital stay. Costs were obtained from the hospital. RESULTS Thirty-four patients were treated with dalbavancin; their mean age was 57.9 years, and 70.6% were men. The main reasons for dalbavancin use were outpatient management (61.7%, n = 21) and ensuring treatment adherence (26.5%, n = 9). The main indications were: osteoarticular infection (32.4%) and infective endocarditis (29.4%). One-half (50%) of the infections were due to Staphylococcus aureus (23.5% were methicillin resistant). All patients achieved clinical resolution, and no costs associated with dalbavancin-associated adverse events or re-admissions were reported. The mean total cost of treatment was 22,738€per patient, with the greatest expenditures in interventions (8,413€) and hospital stay (6,885€). The mean cost of dalbavancin treatment was 3,936€; without dalbavancin, this cost could have been increased to 3,324-11,038€depending on the scenario, mainly due to hospital stays. MAIN LIMITATION Limited sample size obtained from a single centre. CONCLUSION The economic impact of the management of these infections is high. The cost of dalbavancin is offset by the decreased length of stay.
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Affiliation(s)
- Maricela Valerio
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Cristina Veintimilla
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Carmen Rodríguez
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Sofía de la Villa
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Mar Sánchez-Somolinos
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Carlos Crespo
- Axentiva Solutions S.L., Barcelona, Spain
- Universidad de Barcelona, Barcelona, Spain
| | - Sara Rodríguez
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Iván Adan
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Esther Chamorro
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Patricia Muñoz
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
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22
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Lueking R, Wei W, Mang NS, Ortwine JK, Meisner J. Evaluation of Dalbavancin Use on Clinical Outcomes, Cost-Savings, and Adherence at a Large Safety Net Hospital. Microbiol Spectr 2023; 11:e0238522. [PMID: 36537818 PMCID: PMC9927367 DOI: 10.1128/spectrum.02385-22] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 11/18/2022] [Indexed: 02/16/2023] Open
Abstract
Dalbavancin is a second-generation lipoglycopeptide antibiotic with activity against Gram-positive organisms. Dalbavancin is Food and Drug Administration (FDA)-approved for acute bacterial skin and soft tissue infections (ABSSTIs). There is a lack of substantial data on dalbavancin in more invasive infections, particularly in high-risk populations (patients with intravenous drug use and unstable living conditions). In this retrospective observational study, we reviewed all patients that received at least one dose of dalbavancin in an inpatient or outpatient setting at Parkland Hospital from February of 2019 to August of 2021. The demographics, type of infection, and rationale for dalbavancin were collected at the baseline. Clinical failure was measured by an avoidance of emergency department (ED) visits or hospital readmission at 30, 60, and 90 days. A separate analysis was conducted to estimate hospital, rehabilitation, or nursing facility days saved based on the projected length of treatment. 40 patients were included, and the majority were uninsured (85%), experiencing homelessness (60%), or had intravenous drug use (IDU) (57.5%). Indications for use included ABSSTIs (45%), bloodstream infection (67.5%), osteomyelitis (40%), infective endocarditis (10%), and septic arthritis (10%). Clinical failure was observed in 5 of the 40 patients (12.5%). Nonadherence to medical recommendations, a lack of source control, and ongoing IDU increased the risk of failure. Dalbavancin saved a total of 566 days of inpatient, rehabilitation, and nursing facility stays. Dalbavancin is a reasonable alternative to the standard of care in an at-risk population, offering decreased lengths of stays and cost savings. The uses of second-generation lipoglycopeptides are desirable alternatives to traditional outpatient parenteral antibiotic therapies for patients who otherwise would not qualify or for patients who desire less hospital contact in light of the COVID-19 pandemic. IMPORTANCE This study contributes additional experience to the literature of dalbavancin use in off-label indications, particularly for patients who do not qualify for outpatient parenteral antimicrobial therapy. The majority of the patient population were people who inject drugs and the uninsured. There is difficulty in tracking outcomes in this patient population, given their outpatient follow-up rates; however, we were able to track emergency room visits and readmissions throughout the majority of the local metroplex. The clinical use of dalbavancin at our institution also increased in the midst of the COVID-19 pandemic in an effort to preserve hospital resources and limit health care exposure. In addition, we are able to provide institution-specific cost-saving data with the use of dalbavancin.
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Affiliation(s)
- Richard Lueking
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, University of Texas Southwestern, Dallas, Texas, USA
| | - Wenjing Wei
- Department of Pharmacy Services, Parkland Health, Dallas, Texas, USA
| | - Norman S. Mang
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, University of Texas Southwestern, Dallas, Texas, USA
| | - Jessica K. Ortwine
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, University of Texas Southwestern, Dallas, Texas, USA
| | - Jessica Meisner
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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23
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Rich KM, Solomon DA. Medical Complications of Injection Drug Use - Part I. NEJM EVIDENCE 2023; 2:EVIDra2200292. [PMID: 38320040 DOI: 10.1056/evidra2200292] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Medical Complications of Injection Drug Use - Part IDuring the past 2 decades, the risk of death and the prevalence of hospitalizations in the United States have increased substantially among people who inject drugs, in large part because of the opioid epidemic. This article reviews the complications observed in people who inject drugs as well as strategies to reduce harm.
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Affiliation(s)
| | - Daniel A Solomon
- Harvard Medical School, Boston
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston
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24
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Blaskovich MAT, Hansford KA, Butler MS, Ramu S, Kavanagh AM, Jarrad AM, Prasetyoputri A, Pitt ME, Huang JX, Lindahl F, Ziora ZM, Bradford T, Muldoon C, Rajaratnam P, Pelingon R, Edwards DJ, Zhang B, Amado M, Elliott AG, Zuegg J, Coin L, Woischnig AK, Khanna N, Breidenstein E, Stincone A, Mason C, Khan N, Cho HK, Karau MJ, Greenwood-Quaintance KE, Patel R, Wootton M, James ML, Hutton ML, Lyras D, Ogunniyi AD, Mahdi LK, Trott DJ, Wu X, Niles S, Lewis K, Smith JR, Barber KE, Yim J, Rice SA, Rybak MJ, Ishmael CR, Hori KR, Bernthal NM, Francis KP, Roberts JA, Paterson DL, Cooper MA. A lipoglycopeptide antibiotic for Gram-positive biofilm-related infections. Sci Transl Med 2022; 14:eabj2381. [DOI: 10.1126/scitranslmed.abj2381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Drug-resistant Gram-positive bacterial infections are still a substantial burden on the public health system, with two bacteria (
Staphylococcus aureus
and
Streptococcus pneumoniae
) accounting for over 1.5 million drug-resistant infections in the United States alone in 2017. In 2019, 250,000 deaths were attributed to these pathogens globally. We have developed a preclinical glycopeptide antibiotic, MCC5145, that has excellent potency (MIC
90
≤ 0.06 μg/ml) against hundreds of isolates of methicillin-resistant
S. aureus
(MRSA) and other Gram-positive bacteria, with a greater than 1000-fold margin over mammalian cell cytotoxicity values. The antibiotic has therapeutic in vivo efficacy when dosed subcutaneously in multiple murine models of established bacterial infections, including thigh infection with MRSA and blood septicemia with
S. pneumoniae
, as well as when dosed orally in an antibiotic-induced
Clostridioides difficile
infection model. MCC5145 exhibited reduced nephrotoxicity at microbiologically active doses in mice compared to vancomycin. MCC5145 also showed improved activity against biofilms compared to vancomycin, both in vitro and in vivo, and a low propensity to select for drug resistance. Characterization of drug action using a transposon library bioinformatic platform showed a mechanistic distinction from other glycopeptide antibiotics.
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Affiliation(s)
- Mark A. T. Blaskovich
- Centre for Superbug Solutions, Institute for Molecular Bioscience, The University of Queensland, St. Lucia, Queensland 4072, Australia
| | - Karl A. Hansford
- Centre for Superbug Solutions, Institute for Molecular Bioscience, The University of Queensland, St. Lucia, Queensland 4072, Australia
| | - Mark S. Butler
- Centre for Superbug Solutions, Institute for Molecular Bioscience, The University of Queensland, St. Lucia, Queensland 4072, Australia
| | - Soumya Ramu
- Centre for Superbug Solutions, Institute for Molecular Bioscience, The University of Queensland, St. Lucia, Queensland 4072, Australia
| | - Angela M. Kavanagh
- Centre for Superbug Solutions, Institute for Molecular Bioscience, The University of Queensland, St. Lucia, Queensland 4072, Australia
| | - Angie M. Jarrad
- Centre for Superbug Solutions, Institute for Molecular Bioscience, The University of Queensland, St. Lucia, Queensland 4072, Australia
| | - Anggia Prasetyoputri
- Centre for Superbug Solutions, Institute for Molecular Bioscience, The University of Queensland, St. Lucia, Queensland 4072, Australia
| | - Miranda E. Pitt
- Centre for Superbug Solutions, Institute for Molecular Bioscience, The University of Queensland, St. Lucia, Queensland 4072, Australia
| | - Johnny X. Huang
- Centre for Superbug Solutions, Institute for Molecular Bioscience, The University of Queensland, St. Lucia, Queensland 4072, Australia
| | - Fredrik Lindahl
- Centre for Superbug Solutions, Institute for Molecular Bioscience, The University of Queensland, St. Lucia, Queensland 4072, Australia
| | - Zyta M. Ziora
- Centre for Superbug Solutions, Institute for Molecular Bioscience, The University of Queensland, St. Lucia, Queensland 4072, Australia
| | - Tanya Bradford
- Centre for Superbug Solutions, Institute for Molecular Bioscience, The University of Queensland, St. Lucia, Queensland 4072, Australia
| | - Craig Muldoon
- Centre for Superbug Solutions, Institute for Molecular Bioscience, The University of Queensland, St. Lucia, Queensland 4072, Australia
| | - Premraj Rajaratnam
- Centre for Superbug Solutions, Institute for Molecular Bioscience, The University of Queensland, St. Lucia, Queensland 4072, Australia
| | - Ruby Pelingon
- Centre for Superbug Solutions, Institute for Molecular Bioscience, The University of Queensland, St. Lucia, Queensland 4072, Australia
| | - David J. Edwards
- Centre for Superbug Solutions, Institute for Molecular Bioscience, The University of Queensland, St. Lucia, Queensland 4072, Australia
| | - Bing Zhang
- Centre for Superbug Solutions, Institute for Molecular Bioscience, The University of Queensland, St. Lucia, Queensland 4072, Australia
| | - Maite Amado
- Centre for Superbug Solutions, Institute for Molecular Bioscience, The University of Queensland, St. Lucia, Queensland 4072, Australia
| | - Alysha G. Elliott
- Centre for Superbug Solutions, Institute for Molecular Bioscience, The University of Queensland, St. Lucia, Queensland 4072, Australia
| | - Johannes Zuegg
- Centre for Superbug Solutions, Institute for Molecular Bioscience, The University of Queensland, St. Lucia, Queensland 4072, Australia
| | - Lachlan Coin
- Centre for Superbug Solutions, Institute for Molecular Bioscience, The University of Queensland, St. Lucia, Queensland 4072, Australia
| | - Anne-Kathrin Woischnig
- University and University Hospital of Basel, Division of Infectious Diseases and Infection Biology Laboratory Department of Biomedicine, Hebelstrasse 20, CH-4031 Basel, Switzerland
| | - Nina Khanna
- University and University Hospital of Basel, Division of Infectious Diseases and Infection Biology Laboratory Department of Biomedicine, Hebelstrasse 20, CH-4031 Basel, Switzerland
| | - Elena Breidenstein
- Summit Therapeutics, The Works, Unity Campus, Cambridgeshire, CB22 3FT, UK
| | - Anna Stincone
- Summit Therapeutics, The Works, Unity Campus, Cambridgeshire, CB22 3FT, UK
| | - Clive Mason
- Summit Therapeutics, The Works, Unity Campus, Cambridgeshire, CB22 3FT, UK
| | - Nawaz Khan
- Summit Therapeutics, The Works, Unity Campus, Cambridgeshire, CB22 3FT, UK
| | - Hye-Kyung Cho
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
| | - Melissa J. Karau
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
| | - Kerryl E. Greenwood-Quaintance
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
| | - Robin Patel
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Mandy Wootton
- Specialist Antimicrobial Chemotherapy Unit Public Health Wales, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, Wales
| | - Meagan L. James
- Infection and Immunity Program, Monash Biomedicine Discovery Institute and Department of Microbiology, Monash University, Clayton, Victoria 3800, Australia
| | - Melanie L. Hutton
- Infection and Immunity Program, Monash Biomedicine Discovery Institute and Department of Microbiology, Monash University, Clayton, Victoria 3800, Australia
| | - Dena Lyras
- Infection and Immunity Program, Monash Biomedicine Discovery Institute and Department of Microbiology, Monash University, Clayton, Victoria 3800, Australia
| | - Abiodun D. Ogunniyi
- Australian Centre for Antimicrobial Resistance Ecology, School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, South Australia 5371, Australia
| | - Layla K. Mahdi
- Australian Centre for Antimicrobial Resistance Ecology, School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, South Australia 5371, Australia
| | - Darren J. Trott
- Australian Centre for Antimicrobial Resistance Ecology, School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, South Australia 5371, Australia
| | - Xiaoqian Wu
- Antimicrobial Discovery Center, Department of Biology, Northeastern University, 360 Huntington Avenue, Boston, MA 02115, USA
| | - Samantha Niles
- Antimicrobial Discovery Center, Department of Biology, Northeastern University, 360 Huntington Avenue, Boston, MA 02115, USA
| | - Kim Lewis
- Antimicrobial Discovery Center, Department of Biology, Northeastern University, 360 Huntington Avenue, Boston, MA 02115, USA
| | - Jordan R. Smith
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI 48201, USA
| | - Katie E. Barber
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI 48201, USA
| | - Juwon Yim
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI 48201, USA
| | - Seth Alan Rice
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI 48201, USA
| | - Michael J. Rybak
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI 48201, USA
- School of Medicine, Wayne State University, Detroit, MI 48201, USA
| | - Chad R. Ishmael
- Department of Orthopaedic Surgery, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA
| | - Kellyn R. Hori
- Department of Orthopaedic Surgery, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA
| | - Nicholas M. Bernthal
- Department of Orthopaedic Surgery, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA
| | - Kevin P. Francis
- Department of Orthopaedic Surgery, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA
- PerkinElmer, 68 Elm Street, Hopkinton, MA 01748, USA
| | - Jason A. Roberts
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland 4029, Australia
- Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women’s Hospital, Brisbane, Queensland 4029, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, 30029 Nîmes, France
| | - David L. Paterson
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland 4029, Australia
| | - Matthew A. Cooper
- Centre for Superbug Solutions, Institute for Molecular Bioscience, The University of Queensland, St. Lucia, Queensland 4072, Australia
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25
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Righi E, Visentin A, Meroi M, Carrara E, Tacconelli E. Dalbavancin in the treatment of acute bacterial skin and skin structure and other infections: a safety evaluation. Expert Opin Drug Saf 2022; 21:1171-1181. [PMID: 36093622 DOI: 10.1080/14740338.2022.2122437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Dalbavancin is a second-generation lipoglycopeptide that was approved since 2014 to treat acute bacterial skin and skin-structure infections (ABSSSI). Dalbavancin is characterized by Gram-positive activity and novel pharmacokinetic properties that result in a prolonged terminal half-life, allowing once weekly dosing in adults. A good safety profile was reported by randomized clinical trials and meta-analyses. AREAS COVERED Dalbavancin safety and tolerability data from trials and post-marketing studies were reviewed. While most trials included predominantly ABSSSI, 2 clinical trials and recent observational studies have explored the use of dalbavancin for off-label indications, mainly including bloodstream and osteoarticular infections. EXPERT OPINION The occurrence of drug-related adverse effects (AE) was similar between dalbavancin and comparators in clinical trials enrolling patients with ABSSSI. Most common AE included gastrointestinal symptoms, infusion reaction, and hypersensitivity. Low rates of drug discontinuation and serious AE were reported across studies. In the past 5 years, several observational studies have reported safety data on the use of dalbavancin, confirming its favorable safety profile. Nevertheless, data from dalbavancin off-label use often derived from prolonged (> 2 weeks) treatments with variable dosing regimens, were mainly retrospective, and lacked comparators. Further research is required to allow a reliable analysis of short- and long-term dalbavancin-related AE in non-ABSSSI.
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Affiliation(s)
- Elda Righi
- Infectious Diseases Division, Diagnostic and Public Health Department, University of Verona, Italy
| | - Alessandro Visentin
- Infectious Diseases Division, Diagnostic and Public Health Department, University of Verona, Italy
| | - Marco Meroi
- Infectious Diseases Division, Diagnostic and Public Health Department, University of Verona, Italy
| | - Elena Carrara
- Infectious Diseases Division, Diagnostic and Public Health Department, University of Verona, Italy
| | - Evelina Tacconelli
- Infectious Diseases Division, Diagnostic and Public Health Department, University of Verona, Italy
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26
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Attwood LO, McKechnie M, Vujovic O, Higgs P, Lloyd‐Jones M, Doyle JS, Stewardson AJ. Review of management priorities for invasive infections in people who inject drugs: highlighting the need for patient-centred multidisciplinary care. Med J Aust 2022; 217:102-109. [PMID: 35754144 PMCID: PMC9539935 DOI: 10.5694/mja2.51623] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 05/18/2022] [Accepted: 05/30/2022] [Indexed: 09/26/2023]
Abstract
There has been a global increase in the burden of invasive infections in people who inject drugs (PWID). It is essential that patient-centred multidisciplinary care is provided in the management of these infections to engage PWID in care and deliver evidence-based management and preventive strategies. The multidisciplinary team should include infectious diseases, addictions medicine (inclusive of alcohol and other drug services), surgery, psychiatry, pain specialists, pharmacy, nursing staff, social work and peer support workers (where available) to help address the comorbid conditions that may have contributed to the patient's presentation. PWID have a range of antimicrobial delivery options that can be tailored in a patient-centred manner and thus are not limited to prolonged hospital admissions to receive intravenous antimicrobials for invasive infections. These options include discharge with outpatient parenteral antimicrobial therapy, long-acting lipoglycopeptides (dalbavancin and oritavancin) and early oral antimicrobials. Open and respectful discussion with PWID including around harm reduction strategies may decrease the risk of repeat presentations with injecting-related harms.
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Affiliation(s)
| | | | - Olga Vujovic
- Alfred HealthMelbourneVIC
- Monash UniversityMelbourneVIC
| | - Peter Higgs
- Burnet InstituteMelbourneVIC
- La Trobe UniversityMelbourneVIC
| | | | - Joseph S Doyle
- Alfred HealthMelbourneVIC
- Monash UniversityMelbourneVIC
- Burnet InstituteMelbourneVIC
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27
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Diagnosis and Management of Infective Endocarditis in People Who Inject Drugs: JACC State-of-the-Art Review. J Am Coll Cardiol 2022; 79:2037-2057. [PMID: 35589166 DOI: 10.1016/j.jacc.2022.03.349] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 12/16/2022]
Abstract
The incidence of injection drug use-associated infective endocarditis has been increasing rapidly over the last decade. Patients with drug use-associated infective endocarditis present an increasingly common clinical challenge with poor long-term outcomes and high reinfection and readmission rates. Their care raises issues unique to this population, including antibiotic selection and administration, indications for and ethical issues surrounding surgical intervention, and importantly management of the underlying substance use disorder to minimize the risk of reinfection. Successful treatment of these patients requires a broad understanding of these concerns. A multidisciplinary, collaborative approach providing a holistic approach to treating both the acute infection along with effectively addressing substance use disorder is needed to improve short-term and longer-term outcomes.
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28
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New Perspectives on Antimicrobial Agents: Long-Acting Lipoglycopeptides. Antimicrob Agents Chemother 2022; 66:e0261420. [PMID: 35475634 DOI: 10.1128/aac.02614-20] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The long-acting lipoglycopeptides (LGPs) dalbavancin and oritavancin are semisynthetic antimicrobials with broad and potent activity against Gram-positive bacterial pathogens. While they are approved by the Food and Drug Administration for acute bacterial skin and soft tissue infections, their pharmacological properties suggest a potential role of these agents for the treatment of deep-seated and severe infections, such as bloodstream and bone and joint infections. The use of these antimicrobials is particularly appealing when prolonged therapy, early discharge, and avoidance of long-term intravascular catheter access are desirable or when multidrug-resistant bacteria are suspected. This review describes the current evidence for the use of oritavancin and dalbavancin in the treatment of invasive infections, as well as the hurdles that are preventing their optimal use. Moreover, this review discusses the current knowledge gaps that need to be filled to understand the potential role of LGPs in highly needed clinical scenarios and the ongoing clinical studies that aim to address these voids in the upcoming years.
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29
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Gatti M, Barnini S, Guarracino F, Parisio EM, Spinicci M, Viaggi B, D’Arienzo S, Forni S, Galano A, Gemmi F. Orthopaedic Implant-Associated Staphylococcal Infections: A Critical Reappraisal of Unmet Clinical Needs Associated with the Implementation of the Best Antibiotic Choice. Antibiotics (Basel) 2022; 11:antibiotics11030406. [PMID: 35326869 PMCID: PMC8944676 DOI: 10.3390/antibiotics11030406] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 12/24/2022] Open
Abstract
Infections associated with orthopaedic implants represent a major health concern characterized by a remarkable incidence of morbidity and mortality. The wide variety of clinical scenarios encountered in the heterogeneous world of infections associated with orthopaedic implants makes the implementation of an optimal and standardized antimicrobial treatment challenging. Antibiotic bone penetration, anti-biofilm activity, long-term safety, and drug choice/dosage regimens favouring outpatient management (i.e., long-acting or oral agents) play a major role in regards to the chronic evolution of these infections. The aim of this multidisciplinary opinion article is to summarize evidence supporting the use of the different anti-staphylococcal agents in terms of microbiological and pharmacological optimization according to bone penetration, anti-biofilm activity, long-term safety, and feasibility for outpatient regimens, and to provide a useful guide for clinicians in the management of patients affected by staphylococcal infections associated with orthopaedic implants Novel long-acting lipoglycopeptides, and particularly dalbavancin, alone or in combination with rifampicin, could represent the best antibiotic choice according to real-world evidence and pharmacokinetic/pharmacodynamic properties. The implementation of a multidisciplinary taskforce and close cooperation between microbiologists and clinicians is crucial for providing the best care in this scenario.
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Affiliation(s)
- Milo Gatti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy;
- SSD Clinical Pharmacology, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Simona Barnini
- Bacteriology Unit, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy;
| | - Fabio Guarracino
- Department of Anaesthesia and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy;
| | - Eva Maria Parisio
- UOSD Microbiologia Arezzo PO San Donato, Azienda Usl Toscana Sud Est, 52100 Arezzo, Italy;
| | - Michele Spinicci
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy;
- Infectious and Tropical Diseases Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Bruno Viaggi
- Neurointensive Care Unit, Department of Anesthesiology, Careggi University Hospital, 50134 Florence, Italy;
| | - Sara D’Arienzo
- Agenzia Regionale di Sanità della Toscana, 50141 Florence, Italy; (S.D.); (S.F.)
| | - Silvia Forni
- Agenzia Regionale di Sanità della Toscana, 50141 Florence, Italy; (S.D.); (S.F.)
| | - Angelo Galano
- SOD Microbiologia e Virologia, Careggi University Hospital, 50134 Florence, Italy;
| | - Fabrizio Gemmi
- Agenzia Regionale di Sanità della Toscana, 50141 Florence, Italy; (S.D.); (S.F.)
- Correspondence:
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Conte M, Schneider B, Varley CD, Streifel AC, Sikka MK. Description and outcomes of patients with substance use disorder with serious bacterial infections who had a multidisciplinary care conference. Ther Adv Infect Dis 2022; 9:20499361221117974. [PMID: 35992495 PMCID: PMC9389031 DOI: 10.1177/20499361221117974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 07/18/2022] [Indexed: 11/16/2022] Open
Abstract
Background Patients with substance use disorders (SUDs) and severe bacterial infections requiring prolonged antibiotic therapy represent a significant challenge to providers due to complexity of care coordination required to ensure safe and effective treatment. Our institution developed a patient-centered multidisciplinary discharge planning conference, OPTIONS-DC, to address this challenge. Methods We conducted a retrospective review to evaluates parameters between patients who received an OPTIONS-DC and those who did not. Results We identified 73 patients receiving an OPTIONS-DC and 100 who did not. More patients with an OPTIONS-DC were < 40 years of age (76.7% versus 61.0%, OR = 2.3, 95% CI = 1.1-4.7, p = 0.02), had positive HCV antibody testing (58.9% versus 41.0%, OR = 2.1, 95% CI = 1.1-3.8, p = 0.02), injection drug use (93.2% versus 79.0%, OR = 3.6 95% CI = 1.3-10.1, p = 0.01), used methamphetamines (84.9% versus 72.0%, OR = 2.2, 95% CI = 1.0-4.8, p = 0.04), and started inpatient SUD treatment (80.8% versus 63%, OR = 2.5, 95% CI = 1.2-5.0, p = 0.04) compared with those without a conference. The OPTIONS-DC group was more likely to be diagnosed with bacteremia (74.0% versus 57.0%, OR = 2.1, 95% CI = 1.1-4.1, p = 0.02), endocarditis (39.7% versus21.0%, OR = 2.5, 95% CI = 1.3-4.9, p = 0.03), vertebral osteomyelitis (45.2% versus 15.0%, OR = 4.7, 95% CI = 2.3-9.6, p < 0.01), and epidural abscess (35.6% versus 10.0%, OR = 5.0, 95% CI = 2.2-11.2, p < 0.01) and require 4 weeks or more of antibiotic treatment (97.3% versus 51.1%, OR = 34.1, 95% CI = 7.9-146.7, p = 0.01). Patients with an OPTIONS-DC were also more likely to be admitted between 2019 and 2020 than between 2018 and 2019 (OR = 4.1, 95% CI = 2.1-7.9, p < 0.01). Conclusion Patients with an OPTIONS-DC tended to have more complicated infections and longer courses of antibiotic treatment. While further research on outcomes is needed, patients receiving an OPTIONS-DC were able to successfully complete antibiotic courses across a variety of settings.
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Affiliation(s)
- Michael Conte
- Division of Infectious Diseases, School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Brent Schneider
- Division of Infectious Diseases, School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Cara D Varley
- Division of Infectious Diseases, School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Amber C Streifel
- Department of Pharmacy, Oregon Health & Science University, Portland, OR, USA
| | - Monica K Sikka
- Division of Infectious Diseases, School of Medicine, Oregon Health & Science University, Portland, OR 97239-3098, USA
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Outcomes in Patients with Staphylococcus aureus Bacteremia Treated with Dalbavancin in Clinical Trials. Infect Dis Ther 2021; 11:423-434. [PMID: 34905144 PMCID: PMC8847487 DOI: 10.1007/s40121-021-00568-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 11/12/2021] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION Dalbavancin is a long-acting, bactericidal, lipoglycopeptide antibiotic approved by the US Food and Drug Administration and the European Medicines Agency for treatment of acute bacterial skin and skin structure infections in adults, with potent activity against Gram-positive pathogens, including methicillin-susceptible and methicillin-resistant Staphylococcus aureus. Here we describe the clearance and clinical outcomes of patients with S. aureus bacteremia in five clinical trials of skin and skin structure infections or catheter-related bloodstream infections that evaluated the efficacy and safety of dalbavancin. METHODS Patients with uncomplicated S. aureus bacteremia identified in blood cultures drawn at baseline (before study drug) with at least one follow-up blood culture are described from four phase 3 trials in skin and skin structure infections and one phase 2 catheter-related infection study. Dalbavancin was administered as a single-dose (1500 mg intravenous [IV]) or a two-dose regimen (1000 mg IV on day 1, 500 mg IV on day 8). Comparators included vancomycin IV or linezolid IV/oral for 10-14 days. RESULTS All 39 patients (100%) who received dalbavancin, including 8 patients on the single-dose regimen, had clearance of bacteremia versus 19/20 patients (95%) treated with comparators (vancomycin or linezolid). At end of treatment, 33/36 dalbavancin-treated patients (92%) achieved clinical success versus 18/23 patients (78%) treated with comparators. CONCLUSIONS All 39 patients with uncomplicated S. aureus bacteremia treated with dalbavancin (single- or two-dose regimen) and with follow-up blood cultures had clearance of their bloodstream infection. Clinical response rates were similar to daily comparator therapy for 10-14 days. TRIAL REGISTRATION DISCOVER 1, NCT01339091; DISCOVER 2, NCT01431339; DUR001-303, NCT02127970; VER001-9; VER001-4, NCT00057369.
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Oliva A, Stefani S, Venditti M, Di Domenico EG. Biofilm-Related Infections in Gram-Positive Bacteria and the Potential Role of the Long-Acting Agent Dalbavancin. Front Microbiol 2021; 12:749685. [PMID: 34745053 PMCID: PMC8569946 DOI: 10.3389/fmicb.2021.749685] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/04/2021] [Indexed: 01/08/2023] Open
Abstract
Infections caused by Gram-positive bacteria are a major public health problem due to their increasing resistance to antibiotics. Staphylococcus and Enterococcus species' resistance and pathogenicity are enhanced by their ability to form biofilm. The biofilm lifestyle represents a significant obstacle to treatment because bacterial cells become highly tolerant to a wide range of antimicrobial compounds normally effective against their planktonic forms. Thus, novel therapeutic strategies targeting biofilms are urgently needed. The lipoglycopeptide dalbavancin is a long-acting agent for treating acute bacterial skin and skin structure infections caused by a broad range of Gram-positive pathogens. Recent studies have shown promising activity of dalbavancin against Gram-positive biofilms, including methicillin-resistant S. aureus (MRSA), methicillin-resistant S. epidermidis (MRSE), and vancomycin-susceptible enterococci. This review outlines the mechanisms regulating biofilm development in Staphylococcus and Enterococcus species and the clinical impact of biofilm-related infections. In addition, it discusses the clinical implications and potential therapeutic perspectives of the long-acting drug dalbavancin against biofilm-forming Gram-positive pathogens.
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Affiliation(s)
- Alessandra Oliva
- Department of Public Health and Infectious Diseases, "La Sapienza" University of Rome, Rome, Italy
| | - Stefania Stefani
- Laboratory of Molecular Medical Microbiology and Antimicrobial Resistance Research (Mmarl), Department of Biomedical and Biotechnological Sciences (Biometec), University of Catania, Catania, Italy
| | - Mario Venditti
- Department of Public Health and Infectious Diseases, "La Sapienza" University of Rome, Rome, Italy
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Cooper MM, Preslaski CR, Shihadeh KC, Hawkins KL, Jenkins TC. Multiple-Dose Dalbavancin Regimens as the Predominant Treatment of Deep-Seated or Endovascular Infections: A Scoping Review. Open Forum Infect Dis 2021; 8:ofab486. [PMID: 34738025 PMCID: PMC8562469 DOI: 10.1093/ofid/ofab486] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 09/24/2021] [Indexed: 11/14/2022] Open
Abstract
Off-label use of dalbavancin for deep-seated and endovascular infections has been increasing. We performed a scoping review to evaluate the evidence for use of multiple-dose dalbavancin regimens as the predominant therapy for these indications. Predominant therapy was defined as use of dalbavancin without other concurrent antibiotics for more than half of the total treatment duration. Fifteen publications were identified; 2 were small, open-label randomized controlled trials and the remainder were retrospective observational studies or case reports. A total of 144 cases from these publications met eligibility criteria for inclusion in this review. Types of infections included osteoarticular infections, catheter-related or complicated bloodstream infections, and infective endocarditis. Overall, the evidence for use of multiple-dose regimens of dalbavancin for deep-seated and endovascular infections is limited by a paucity of data from controlled trials, heterogeneity of dosing regimens, and a lack of standardized clinical outcomes.
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Affiliation(s)
- Margaret M Cooper
- Pharmacy Department, Denver Health Medical Center, Denver, Colorado, USA
- Correspondence: Margaret M. Cooper, PharmD, Pharmacy Department Denver Health Medical Center, 790 Delaware St, MC 0056, Denver, CO 80204, USA ()
| | | | | | - Kellie L Hawkins
- Division of Infectious Diseases, Department of Medicine, Denver Health Medical Center, Denver, Colorado, USA
- Division of Infectious Diseases, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Timothy C Jenkins
- Division of Infectious Diseases, Department of Medicine, Denver Health Medical Center, Denver, Colorado, USA
- Division of Infectious Diseases, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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de Pablo-Miró M, Pujol-Ruiz S, Iftimie S, Arenas-Miras MDM, López-Montesinos I, Duran-Jordà X, Anglès A, Grau S, Horcajada JP. Comparative Analysis of Dalbavancin versus Other Antimicrobial Options for Gram-Positive Cocci Infections: Effectiveness, Hospital Stay and Mortality. Antibiotics (Basel) 2021; 10:antibiotics10111296. [PMID: 34827234 PMCID: PMC8614661 DOI: 10.3390/antibiotics10111296] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 11/16/2022] Open
Abstract
Dalbavancin is a new antibiotic that is effective against Gram-positive microorganisms, including methicillin-resistant Staphylococci, and offers the possibility of administering intravenous therapy once weekly in an ambulatory setting. We conducted a multicenter observational case-control study, comparing all patients who received dalbavancin (cases) with hospitalized patients who were treated instead with daptomycin, linezolid or vancomycin (controls), based on clinical diagnosis, main microorganism involved, and age. The primary outcome was the length of hospital stay after starting the study antimicrobial. Secondary outcomes were 7-day and 30-day efficacy, 30-day mortality, 90-day recurrence, 90-day and 6-month hospitalization, presence of adverse events and healthcare-associated infections; 161 patients (44 cases and 117 controls) were included. Bivariate analysis showed that dalbavancin reduced the total length of hospital stay (p < 0.001), with fewer 90-day recurrences (p = 0.005), 6-month hospitalizations related to the same infection (p = 0.004) and non-related hospitalizations (p = 0.035). Multivariate analyses showed that length of hospital stay was significantly shorter in patients treated with dalbavancin (−12.05 days 95% CI [−17.00, −7.11], p < 0.001), and 30-day efficacy was higher in the dalbavancin group (OR 2.62 95% CI [1.07, 6.37], p = 0.034). Although sample size of the study may be a limitation, we can conclude that Dalbavancin is a useful antimicrobial drug against Gram-positive infections, including multidrug-resistant pathogens, and allows for a remarkable reduction in length of hospital stay with greater 30-day efficacy.
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Affiliation(s)
- Mar de Pablo-Miró
- Department of Infectious Diseases, Hospital del Mar, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain; (M.d.P.-M.); (S.P.-R.); (M.d.M.A.-M.); (I.L.-M.)
- Faculty of Health and Life Sciencies, Universitat Pompeu Fabra, 08003 Barcelona, Spain;
| | - Sergi Pujol-Ruiz
- Department of Infectious Diseases, Hospital del Mar, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain; (M.d.P.-M.); (S.P.-R.); (M.d.M.A.-M.); (I.L.-M.)
- Faculty of Health and Life Sciencies, Universitat Pompeu Fabra, 08003 Barcelona, Spain;
| | - Simona Iftimie
- Infectious Diseases Service, Hospital Universitari Sant Joan de Reus, 43204 Reus, Spain;
| | - María del Mar Arenas-Miras
- Department of Infectious Diseases, Hospital del Mar, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain; (M.d.P.-M.); (S.P.-R.); (M.d.M.A.-M.); (I.L.-M.)
| | - Inmaculada López-Montesinos
- Department of Infectious Diseases, Hospital del Mar, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain; (M.d.P.-M.); (S.P.-R.); (M.d.M.A.-M.); (I.L.-M.)
| | - Xavier Duran-Jordà
- Statistics Service, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain;
| | - Albert Anglès
- Documentation Service, Hospital del Mar, 08003 Barcelona, Spain;
| | - Santiago Grau
- Faculty of Health and Life Sciencies, Universitat Pompeu Fabra, 08003 Barcelona, Spain;
- Pharmacy Service, Hospital del Mar, 08003 Barcelona, Spain
- REIPI (Red Española de Investigación en Patologías Infecciosas)—ISCII (Instituto de Salud Carlos III) Spanish Network for Research in Infectious Diseases, 28029 Madrid, Spain
| | - Juan P. Horcajada
- Department of Infectious Diseases, Hospital del Mar, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain; (M.d.P.-M.); (S.P.-R.); (M.d.M.A.-M.); (I.L.-M.)
- Faculty of Health and Life Sciencies, Universitat Pompeu Fabra, 08003 Barcelona, Spain;
- REIPI (Red Española de Investigación en Patologías Infecciosas)—ISCII (Instituto de Salud Carlos III) Spanish Network for Research in Infectious Diseases, 28029 Madrid, Spain
- Correspondence:
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Rodríguez AA, Otero-González A, Ghattas M, Ständker L. Discovery, Optimization, and Clinical Application of Natural Antimicrobial Peptides. Biomedicines 2021; 9:1381. [PMID: 34680498 PMCID: PMC8533436 DOI: 10.3390/biomedicines9101381] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 09/28/2021] [Indexed: 12/12/2022] Open
Abstract
Antimicrobial peptides (AMPs) are widespread in multicellular organisms. These structurally diverse molecules are produced as the first line of defense against pathogens such as bacteria, viruses, fungi, and parasites. Also known as host defense peptides in higher eukaryotic organisms, AMPs display immunomodulatory and anticancer activities. During the last 30 years, technological advances have boosted the research on antimicrobial peptides, which have also attracted great interest as an alternative to tackling the antimicrobial resistance scenario mainly provoked by some bacterial and fungal pathogens. However, the introduction of natural AMPs in clinical trials faces challenges such as proteolytic digestion, short half-lives, and cytotoxicity upon systemic and oral application. Therefore, some strategies have been implemented to improve the properties of AMPs aiming to be used as effective therapeutic agents. In the present review, we summarize the discovery path of AMPs, focusing on preclinical development, recent advances in chemical optimization and peptide delivery systems, and their introduction into the market.
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Affiliation(s)
- Armando A. Rodríguez
- Core Facility for Functional Peptidomics, Ulm University Medical Center, 89081 Ulm, Germany
- Core Unit of Mass Spectrometry and Proteomics, Ulm University Medical Center, 89081 Ulm, Germany
| | | | - Maretchia Ghattas
- Faculty of Pharmacy and Biotechnology, German University in Cairo (GUC), Cairo 11511, Egypt;
| | - Ludger Ständker
- Core Facility for Functional Peptidomics, Ulm University Medical Center, 89081 Ulm, Germany
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Brescini L, Della Martera F, Morroni G, Mazzanti S, Di Pietrantonio M, Mantini P, Candelaresi B, Pallotta F, Olivieri S, Iencinella V, Castelletti S, Cocci E, Polo RG, Veccia S, Cirioni O, Tavio M, Giacometti A. Use of Dalbavancin in Skin, Bone and Joint Infections: A Real-Life Experience in an Italian Center. Antibiotics (Basel) 2021; 10:antibiotics10091129. [PMID: 34572711 PMCID: PMC8468778 DOI: 10.3390/antibiotics10091129] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/23/2021] [Accepted: 09/15/2021] [Indexed: 11/16/2022] Open
Abstract
Dalbavancin is a lipoglycopeptide approved for the treatment of acute bacterial skin and skin structure infections (ABSSSI). The aim of the study was to evaluate the efficacy and safety in all patients who received at least one administration of dalbavancin. METHODS We carried out a retrospective study of the use of dalbavancin in 55 patients at the Azienda Ospedaliera Ospedali Riuniti Umberto I (Ancona, Italy) from February 2017 to May 2020 and compared "on label" and "off label" use of dalbavancin in ABSSSI and non-ABSSSI. RESULTS A total of 55 patients were included in the study. The median age was 61 years; 51% had ABSSSI; 24% had prosthetic joint infections, and 14% had osteomyelitis. A total of 53% received a single 1500 mg infusion of dalbavancin, and 18% received a second dose 14 days later; 24% of patients received further doses at 14-day intervals. In 91% of cases, patients achieved clinical objectives with dalbavancin: 96% of patients with ABSSSI and 69% of those with prosthetic joint infections. CONCLUSIONS Dalbavancin was shown to have an excellent tolerability profile and to be a highly successful therapeutic approach even in those cases treated "off-label".
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Affiliation(s)
- Lucia Brescini
- Infectious Diseases Clinic, Ospedali Riuniti Umberto I, Via Conca 71, 60126 Torrette, AN, Italy; (F.D.M.); (S.M.); (M.D.P.); (P.M.); (B.C.); (F.P.); (S.O.); (S.V.); (O.C.); (A.G.)
- Department of Biomedical Sciences and Public Health, Polytechnic University of Marche Medical School, Via Tronto 10/a, 60020 Torrette, AN, Italy; (G.M.); (V.I.)
- Correspondence: ; Tel.: +39-071-596-3502
| | - Filippo Della Martera
- Infectious Diseases Clinic, Ospedali Riuniti Umberto I, Via Conca 71, 60126 Torrette, AN, Italy; (F.D.M.); (S.M.); (M.D.P.); (P.M.); (B.C.); (F.P.); (S.O.); (S.V.); (O.C.); (A.G.)
- Department of Biomedical Sciences and Public Health, Polytechnic University of Marche Medical School, Via Tronto 10/a, 60020 Torrette, AN, Italy; (G.M.); (V.I.)
| | - Gianluca Morroni
- Department of Biomedical Sciences and Public Health, Polytechnic University of Marche Medical School, Via Tronto 10/a, 60020 Torrette, AN, Italy; (G.M.); (V.I.)
| | - Sara Mazzanti
- Infectious Diseases Clinic, Ospedali Riuniti Umberto I, Via Conca 71, 60126 Torrette, AN, Italy; (F.D.M.); (S.M.); (M.D.P.); (P.M.); (B.C.); (F.P.); (S.O.); (S.V.); (O.C.); (A.G.)
- Department of Biomedical Sciences and Public Health, Polytechnic University of Marche Medical School, Via Tronto 10/a, 60020 Torrette, AN, Italy; (G.M.); (V.I.)
| | - Maria Di Pietrantonio
- Infectious Diseases Clinic, Ospedali Riuniti Umberto I, Via Conca 71, 60126 Torrette, AN, Italy; (F.D.M.); (S.M.); (M.D.P.); (P.M.); (B.C.); (F.P.); (S.O.); (S.V.); (O.C.); (A.G.)
- Department of Biomedical Sciences and Public Health, Polytechnic University of Marche Medical School, Via Tronto 10/a, 60020 Torrette, AN, Italy; (G.M.); (V.I.)
| | - Paolo Mantini
- Infectious Diseases Clinic, Ospedali Riuniti Umberto I, Via Conca 71, 60126 Torrette, AN, Italy; (F.D.M.); (S.M.); (M.D.P.); (P.M.); (B.C.); (F.P.); (S.O.); (S.V.); (O.C.); (A.G.)
- Department of Biomedical Sciences and Public Health, Polytechnic University of Marche Medical School, Via Tronto 10/a, 60020 Torrette, AN, Italy; (G.M.); (V.I.)
| | - Bianca Candelaresi
- Infectious Diseases Clinic, Ospedali Riuniti Umberto I, Via Conca 71, 60126 Torrette, AN, Italy; (F.D.M.); (S.M.); (M.D.P.); (P.M.); (B.C.); (F.P.); (S.O.); (S.V.); (O.C.); (A.G.)
- Department of Biomedical Sciences and Public Health, Polytechnic University of Marche Medical School, Via Tronto 10/a, 60020 Torrette, AN, Italy; (G.M.); (V.I.)
| | - Francesco Pallotta
- Infectious Diseases Clinic, Ospedali Riuniti Umberto I, Via Conca 71, 60126 Torrette, AN, Italy; (F.D.M.); (S.M.); (M.D.P.); (P.M.); (B.C.); (F.P.); (S.O.); (S.V.); (O.C.); (A.G.)
- Department of Biomedical Sciences and Public Health, Polytechnic University of Marche Medical School, Via Tronto 10/a, 60020 Torrette, AN, Italy; (G.M.); (V.I.)
| | - Silvia Olivieri
- Infectious Diseases Clinic, Ospedali Riuniti Umberto I, Via Conca 71, 60126 Torrette, AN, Italy; (F.D.M.); (S.M.); (M.D.P.); (P.M.); (B.C.); (F.P.); (S.O.); (S.V.); (O.C.); (A.G.)
- Department of Biomedical Sciences and Public Health, Polytechnic University of Marche Medical School, Via Tronto 10/a, 60020 Torrette, AN, Italy; (G.M.); (V.I.)
| | - Valentina Iencinella
- Department of Biomedical Sciences and Public Health, Polytechnic University of Marche Medical School, Via Tronto 10/a, 60020 Torrette, AN, Italy; (G.M.); (V.I.)
- Infectious Diseases, Ospedali Riuniti Umberto I, ViaConca 71, 60126 Torrette, AN, Italy; (S.C.); (M.T.)
| | - Sefora Castelletti
- Infectious Diseases, Ospedali Riuniti Umberto I, ViaConca 71, 60126 Torrette, AN, Italy; (S.C.); (M.T.)
| | - Emanuele Cocci
- Hospital Pharmacy, Ospedali Riuniti Umberto I, Via Conca 71, 60126 Torrette, AN, Italy; (E.C.); (R.G.P.)
| | - Rosaria G. Polo
- Hospital Pharmacy, Ospedali Riuniti Umberto I, Via Conca 71, 60126 Torrette, AN, Italy; (E.C.); (R.G.P.)
| | - Salvatore Veccia
- Infectious Diseases Clinic, Ospedali Riuniti Umberto I, Via Conca 71, 60126 Torrette, AN, Italy; (F.D.M.); (S.M.); (M.D.P.); (P.M.); (B.C.); (F.P.); (S.O.); (S.V.); (O.C.); (A.G.)
| | - Oscar Cirioni
- Infectious Diseases Clinic, Ospedali Riuniti Umberto I, Via Conca 71, 60126 Torrette, AN, Italy; (F.D.M.); (S.M.); (M.D.P.); (P.M.); (B.C.); (F.P.); (S.O.); (S.V.); (O.C.); (A.G.)
- Department of Biomedical Sciences and Public Health, Polytechnic University of Marche Medical School, Via Tronto 10/a, 60020 Torrette, AN, Italy; (G.M.); (V.I.)
| | - Marcello Tavio
- Infectious Diseases, Ospedali Riuniti Umberto I, ViaConca 71, 60126 Torrette, AN, Italy; (S.C.); (M.T.)
| | - Andrea Giacometti
- Infectious Diseases Clinic, Ospedali Riuniti Umberto I, Via Conca 71, 60126 Torrette, AN, Italy; (F.D.M.); (S.M.); (M.D.P.); (P.M.); (B.C.); (F.P.); (S.O.); (S.V.); (O.C.); (A.G.)
- Department of Biomedical Sciences and Public Health, Polytechnic University of Marche Medical School, Via Tronto 10/a, 60020 Torrette, AN, Italy; (G.M.); (V.I.)
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Role or oritavancin and dalbavancin in acute bacterial skin and skin structure infections and other potential indications. Curr Opin Infect Dis 2021; 34:96-108. [PMID: 33405480 DOI: 10.1097/qco.0000000000000714] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW To discuss the currently available evidence about the use oritavancin and dalbavancin for the treatment of acute bacterial skin and skin structure infections (ABSSSI) and for other potential indications. RECENT FINDINGS In this review, we briefly summarize the available data on efficacy (from randomized controlled trials) and on effectiveness and cure rates (from observational studies) pertaining to the use of oritavancin and dalbavancin either for ABSSSI or for other indications. SUMMARY Oritavancin and dalbavancin are valid options for outpatient therapy and early discharge in patients with ABSSSI, especially when adherence to oral therapy cannot be guaranteed or no oral choices are available. Furthermore, it is worth noting that a non-negligible portion (sometimes the majority) of oritavancin and dalbavancin use in available real-life experiences is for indications other than ABSSSI, especially for Gram-positive osteomyelitis and endocarditis. The number of studies on the use of long-acting lipoglycopeptides for these currently off-label indications is rapidly increasing and will help to further optimize the use of these peculiar antibiotics in the forthcoming future.
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Gatti M, Andreoni M, Pea F, Viale P. Real-World Use of Dalbavancin in the Era of Empowerment of Outpatient Antimicrobial Treatment: A Careful Appraisal Beyond Approved Indications Focusing on Unmet Clinical Needs. DRUG DESIGN DEVELOPMENT AND THERAPY 2021; 15:3349-3378. [PMID: 34376971 PMCID: PMC8349200 DOI: 10.2147/dddt.s313756] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 07/21/2021] [Indexed: 12/26/2022]
Abstract
Dalbavancin is a novel, long-acting lipoglycopeptide characterized by a long elimination half-life coupled with excellent in vitro activity against multidrug-resistant Gram-positives. Although it is currently approved only for the treatment of acute bacterial skin and skin structure infections, an ever-growing amount of evidence supports the efficacy of dalbavancin as a long-term therapy in osteomyelitis, prosthetic joint infections, endocarditis, and bloodstream infections. This article provides a critical reappraisal of real-world use of dalbavancin for off-label indications. A search strategy using specific keywords (dalbavancin, osteomyelitis, endocarditis, long-term suppressive therapy, bloodstream infection, pharmacokinetic/pharmacodynamic profile) until April 2021 was performed on the PubMed-MEDLINE database. As for other novel antibiotics, a conundrum between approved indications and potential innovative therapeutic uses has emerged for dalbavancin as well. The promising efficacy in challenging scenarios (i.e., osteomyelitis, endocarditis, prosthetic joint infections), coupled with the unique pharmacokinetic/pharmacodynamic properties, makes dalbavancin a valuable alternative to daily in-hospital intravenous or outpatient antimicrobial regimens in the treatment of long-term Gram-positive infections. This makes dalbavancin valuable in the current COVID-19 scenario, in which hospitalization and territorial medicine empowerment are unavoidable.
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Affiliation(s)
- Milo Gatti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.,SSD Clinical Pharmacology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Massimo Andreoni
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.,Infectious Diseases Clinic, University Hospital "Tor Vergata", Rome, Italy
| | - Federico Pea
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.,SSD Clinical Pharmacology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.,Infectious Disease Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Almangour TA, Alhifany AA. Dalbavancin for the management of osteomyelitis: a major step forward? J Antimicrob Chemother 2021; 75:2717-2722. [PMID: 32457989 DOI: 10.1093/jac/dkaa188] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Osteomyelitis is one of the most challenging infectious diseases to treat and is associated with a significant burden to healthcare systems. There are limited available therapeutic options to treat osteomyelitis caused by Gram-positive pathogens and these are not without limitations. Dalbavancin is a long-acting lipoglycopeptide, approved for the treatment of acute bacterial skin and skin structure infections caused by designated susceptible strains of Gram-positive microorganisms. It demonstrated promising pharmacokinetic/pharmacodynamic properties and safety data to be considered for the treatment of bone infections. However, information on the effectiveness and safety of dalbavancin in the treatment of invasive Gram-positive infections, such as osteomyelitis, is very limited. In this review, we describe the novel characteristics and potential utility of dalbavancin in the treatment of osteomyelitis and summarize its long-term clinical outcomes from published case reports, series and comparative studies.
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Affiliation(s)
- Thamer A Almangour
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, PO Box 2457, Riyadh 11451, Saudi Arabia
| | - Abdullah A Alhifany
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, PO Box 13578, Makkah 21955, Saudi Arabia
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Monteagudo-Martínez N, Solís-García Del Pozo J, Ikuta I, Galindo M, Jordán J. Systematic review and meta-analysis on the safety of dalbavancin. Expert Opin Drug Saf 2021; 20:1095-1107. [PMID: 34042549 DOI: 10.1080/14740338.2021.1935864] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Dalbavancin is a semisynthetic lipoglycopeptide antimicrobial agent with activity against Gram-positive bacteria including anaerobes. RESEARCH DESIGN AND METHODS Meta-analysis of randomized control trials and large case series (more than 20 patients), were identified by searching Pubmed and Cochrane databases through 14 December 2020. RESULTS 3,073 patients from 6 RCTs met the inclusion criteria. Treatment emergent adverse effects were described in 30.6% dalbavancin patients, and 38.1% patients with other treatments. Our meta-analysis supports favorable results for dalbavancin treatment (OR 0.79; 95%CI 0.66-0.94; p = 0.01). 2.74% dalbavancin patients had to discontinue treatment versus 2.49% patients on other antibiotics. 4.80% dalbavancin patients versus 5.30% patients with other treatments had severe adverse events. 0.31% in the dalbavancin group and 0.95% receiving other antibiotics died. There was no statistically significant difference in severe adverse effects with OR 0.77; 95% CI 0.52-1.14; p = 0.19. Dalbavancin therapy was shown to have statistically significant lower mortality rate (OR 0.26; 95% CI 0.07-0.90; p = 0.03). Observational studies reported few side effects but included a heterogeneous population of patients concerning their diagnosis and the duration of antibiotic treatment. CONCLUSIONS Dalbavancin has comparable safety profile relative to other antibiotics and is well-tolerated.
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Affiliation(s)
- N Monteagudo-Martínez
- Department of Pharmacy. Gerencia De Atención Integrada De Villarrobledo, Albacete, Spain
| | - J Solís-García Del Pozo
- Infectious Diseases Unit. Department of Internal Medicine. Gerencia De Atención Integrada De Albacete, Albacete, Spain
| | - Ichiro Ikuta
- Department of Radiology & Biomedical Imaging Yale University School of Medicine, New Haven, Connecticut, USA
| | - Mf Galindo
- Pharmaceutical Technologic. Medical Sciences Department. Albacete School of Pharmacy. University of Castilla-La Mancha, Albacete, Spain
| | - J Jordán
- Pharmacology. Medical Sciences Department. Albacete School of Medicine. University of Castilla-La Mancha, Albacete, Spain
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Serota DP, Chueng TA, Schechter MC. Applying the Infectious Diseases Literature to People who Inject Drugs. Infect Dis Clin North Am 2021; 34:539-558. [PMID: 32782101 DOI: 10.1016/j.idc.2020.06.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
People who inject drugs (PWID) presenting with injection drug use-associated infections are an understudied population excluded from most prospective infectious disease (ID) clinical trials. Careful application of the existing ID literature to PWID must consider their unique medical, psychological, and social challenges. Identification and treatment of the underlying substance use disorder are key underpinnings to any successful ID intervention.
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Affiliation(s)
- David P Serota
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, 1120 Northwest 14 Street, Suite 851, Miami, FL 33136, USA.
| | - Teresa A Chueng
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, 1120 Northwest 14 Street, Suite 851, Miami, FL 33136, USA; Jackson Memorial Hospital, Jackson Health System, Miami, FL, USA. https://twitter.com/teresachueng
| | - Marcos C Schechter
- Division of Infectious Diseases, Department of Medicine, Emory University, 49 Jesse Hill Jr Dr SE, Atlanta, GA 30303, USA. https://twitter.com/limbsandlungs
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Hurley H, Sikka M, Jenkins T, Cari EV, Thornton A. Outpatient Antimicrobial Treatment for People Who Inject Drugs. Infect Dis Clin North Am 2021; 34:525-538. [PMID: 32782100 DOI: 10.1016/j.idc.2020.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
This article reviews the changing epidemiology of infections associated with injection drug use, perceived barriers to care, features of successful programs for outpatient antimicrobial treatment, models of shared decision making at the time of discharge, and linkage to preventative care after antimicrobial completion. In the search for patient-centered care associated with a rising substance use epidemic, one must continue to strive for novel collaborative approaches to ensure that each person is treated in the best way possible to successfully complete antimicrobial therapy, and then linked to a path of lifelong health care.
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Affiliation(s)
- Hermione Hurley
- Center for Addiction Medicine, Denver Health and Hospital Authority, 667 Bannock Street, MC 3450, Denver, CO 80204, USA.
| | - Monica Sikka
- Division of Infectious Diseases, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, L457, Portland, OR 97239, USA
| | - Timothy Jenkins
- Division of Infectious Disease, Denver Health and Hospital Authority, 601 Broadway, MC4000, Denver, CO 80204, USA
| | - Evelyn Villacorta Cari
- Division of Infectious Disease, University of Kentucky College of Medicine, 740 South Limestone, K512, Lexington, KY 40536-0284, USA
| | - Alice Thornton
- Division of Infectious Disease, University of Kentucky College of Medicine, 740 South Limestone, K512, Lexington, KY 40536-0284, USA
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Cooper CC, Stein GE, Mitra S, Abubaker A, Havlichek DH. Long-Acting Lipoglycopeptides for the Treatment of Bone and Joint Infections. Surg Infect (Larchmt) 2021; 22:771-779. [PMID: 33835882 DOI: 10.1089/sur.2020.413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background: The long-acting lipoglycopeptides dalbavancin and oritavancin possess excellent microbiologic activity against gram-positive bacteria and provide prolonged tissue exposure at sites of infection. Moreover, these antibiotics are well tolerated and do not require therapeutic drug monitoring. Methods: Pharmacokinetic/pharmacodynamic experiments ascertained that one to two doses of these long-acting agents can provide an extended period (≥6 weeks) of antimicrobial therapy. Results: Clinical studies subsequently found that microbiologic and clinical response rates with these agents were comparable to standard antibiotic agents used in the treatment of bone and joint infections. In addition, pharmacoeconomic analyses have discovered cost savings with the use of these antimicrobial agents in the treatment of serious deep-seated bacterial infections. Conclusions: Thus, these long-acting lipoglycopeptides offer potential for cost-effective outpatient parenteral antibiotic therapy of difficult to treat infections, such as osteomyelitis.
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Affiliation(s)
- Christopher C Cooper
- Michigan State University College of Human Medicine, East Lansing, Michigan, USA
| | - Gary E Stein
- Michigan State University College of Human Medicine, East Lansing, Michigan, USA
| | - Subhashis Mitra
- Michigan State University College of Human Medicine, East Lansing, Michigan, USA
| | - Ahmed Abubaker
- Michigan State University College of Human Medicine, East Lansing, Michigan, USA
| | - Daniel H Havlichek
- Michigan State University College of Human Medicine, East Lansing, Michigan, USA
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Falcone M, Meier JJ, Marini MG, Caccialanza R, Aguado JM, Del Prato S, Menichetti F. Diabetes and acute bacterial skin and skin structure infections. Diabetes Res Clin Pract 2021; 174:108732. [PMID: 33676996 DOI: 10.1016/j.diabres.2021.108732] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/09/2021] [Accepted: 02/18/2021] [Indexed: 12/12/2022]
Abstract
Acute bacterial skin and skin structures infections (ABSSSIs) are associated with high morbidity, costs and mortality in patients with diabetes mellitus. Their appropriate management should include several figures and a well-organized approach. This review aims to highlight the interplay between diabetes and ABSSSIs and bring out the unmet clinical needs in this area. Pathogenetic mechanisms underlying the increased risk of ABSSSIs in diabetes mellitus are multifactorial: high glucose levels play a crucial pathogenetic role in the tissue damage and delayed clinical cure. Moreover, the presence of diabetes complications (neuropathy, vasculopathy) further complicates the management of ABSSSIs in patients with diabetes. Multidrug resistance organisms should be considered in this population based on patient risk factors and local epidemiology and etiological diagnosis should be obtained whenever possible. Moreover, drug-drug interactions and drug-related adverse events (such as nephrotoxicity) should be considered in the choice of antibiotic therapy. Reducing unnecessary hospitalizations and prolonged length of hospital stay is of primary importance now, more than ever. To achieve these objectives, a better knowledge of the interplay between acute and chronic hyperglycemia, multidrug resistant etiology, and short and long-term outcome is needed. Of importance, a multidisciplinary approach is crucial to achieve full recovery of these patients.
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Affiliation(s)
- Marco Falcone
- Department of Clinical and Experimental Medicine, Infectious Diseases Unit, University of Pisa, Pisa, Italy.
| | - Juris J Meier
- Diabetes-Zentrum Bochum/Hattingen, Katholisches Klinikum Bochum, Bochum, Germany
| | - Maria Giulia Marini
- Area Sanità e Salute di Fondazione ISTUD, via Paolo Lomazzo 19, 20124, Milan, Italy
| | - Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - José María Aguado
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain
| | - Stefano Del Prato
- Department of Clinical and Experimental Medicine, Section of Metabolic Diseases and Diabetes, University of Pisa, Pisa, Italy
| | - Francesco Menichetti
- Department of Clinical and Experimental Medicine, Infectious Diseases Unit, University of Pisa, Pisa, Italy
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Simonetti O, Rizzetto G, Molinelli E, Cirioni O, Offidani A. Review: A Safety Profile of Dalbavancin for On- and Off-Label Utilization. Ther Clin Risk Manag 2021; 17:223-232. [PMID: 33790563 PMCID: PMC7997409 DOI: 10.2147/tcrm.s271445] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/09/2021] [Indexed: 12/20/2022] Open
Abstract
Introduction Dalbavancin is a bactericidal lipoglycopeptide active against gram-positives. Its use has been approved for the treatment of acute bacterial skin and skin structure infections (ABSSSI). Methods We conducted a narrative review of the literature on the safety profile of dalbavancin. The bibliographic research was carried out on the PubMed database on 6 November 2020 by seeking combinations of the following keywords: dalbavancin, adverse effects, safety, drug interactions, and skin infections. Results Five double-blind Phase 3 randomized clinical trials, 2 open-label randomized trials, and 4 retrospective studies were identified. No statistically significant differences were found between dalbavancin and comparators in the incidence of adverse events. Retrospective studies confirm the low incidence of adverse events. Conclusion Dalbavancin is a therapeutic option that has demonstrated an excellent safety profile, also in relation to the other MRSA therapies available. Its use represents a cost-effective solution for the treatment of those patients with ABSSSI who would need hospitalization. One limitation of this study is that most of the available data are from Phase III clinical trials. Further real-life studies with a larger sample size are therefore needed to better assess the safety profile of the dalbavancin, especially to investigate the true incidence of rare adverse events.
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Affiliation(s)
- Oriana Simonetti
- Clinic of Dermatology, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Giulio Rizzetto
- Clinic of Dermatology, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Elisa Molinelli
- Clinic of Dermatology, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Oscar Cirioni
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, Ancona, Italy
| | - Annamaria Offidani
- Clinic of Dermatology, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
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Andreoni M, Bassetti M, Corrao S, De Rosa FG, Esposito V, Falcone M, Grossi P, Pea F, Petrosillo N, Tascini C, Venditti M, Viale P. The role of dalbavancin for Gram positive infections in the COVID-19 era: state of the art and future perspectives. Expert Rev Anti Infect Ther 2021; 19:1125-1134. [PMID: 33682593 DOI: 10.1080/14787210.2021.1894130] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The COVID-19 pandemic has dramatically challenged the national health systems worldwide in the last months. Dalbavancin is a novel antibiotic with a long plasmatic half-life and simplified weekly administration regimens, thus representing a promising option for the outpatient treatment of Gram-positive infections and the early discharge of hospitalized patients. Dalbavancin is approved for the treatment of acute bacterial skin and skin structure infections (ABSSSIs). Many preliminary data seem to support its use in other indications, such as osteomyelitis, prosthetic joint infections, and infective endocarditis. AREAS COVERED A search in the literature using validated keywords (dalbavancin, Gram-positive infections, Gram-positive cocci, ABSSSI, intravenous treatment, and long-acting antibiotics) was conducted on biomedical bibliographic databases (PubMed and Embase) from 2004 to 30 September 2020. Results were analyzed during two consensus conferences with the aim to review the current evidence on dalbavancin in Gram-positive infections, mainly ABSSSI, osteomyelitis, and infective endocarditis, highlight the main limitations of available studies and suggest possible advantages of the molecule. EXPERT OPINION The board identifies some specific subgroups of patients with ABSSSIs who could mostly benefit from a treatment with dalbavancin and agrees that the design of homogenous and robust studies would allow a broader use of dalbavancin even in other clinical settings.
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Affiliation(s)
- Massimo Andreoni
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy; Infectious Diseases Clinic, University Hospital "Tor Vergata", Rome, Italy
| | - Matteo Bassetti
- Infectious Diseases Clinic, Policlinico San Martino Hospital and Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Salvatore Corrao
- ARNAS Civico Di Cristina Benfratelli Hospital Trust, Palermo; PROMISE Department, University of Palermo School of Medicine, Palermo, Italy
| | | | - Vincenzo Esposito
- Department of Infectious Diseases and Infectious Emergencies, Immunodeficiences and Gender Related Infectious Diseases, Cotugno Hospital A.O. Dei Colli, Napoli, Italy
| | - Marco Falcone
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Paolo Grossi
- Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria and ASST-Sette Laghi, Varese, Italy
| | - Federico Pea
- Department of Medical and Surgical Sciences, University of Bologna - IRRCS Policlinico St Orsola, Bologna, Italy
| | - Nicola Petrosillo
- Clinical and Research Department, National Institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy
| | - Carlo Tascini
- Department of Medicine, University of Udine, Udine, Italy
| | - Mario Venditti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, University of Bologna - IRRCS Policlinico St Orsola, Bologna, Italy
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Ceniceros AG, Shridhar N, Fazzari M, Felsen U, Fox AD. Low Use of Outpatient Parenteral Antimicrobial Therapy for Drug Use-Associated Infective Endocarditis in an Urban Hospital System. Open Forum Infect Dis 2021; 8:ofab083. [PMID: 33796596 PMCID: PMC7990064 DOI: 10.1093/ofid/ofab083] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/12/2021] [Indexed: 01/30/2023] Open
Abstract
Background The opioid crisis in the United States has led to increasing hospitalizations for drug use-associated infective endocarditis (DUA-IE). Outpatient parenteral antimicrobial therapy (OPAT), the preferred modality for intravenous antibiotics for infective endocarditis, has demonstrated similar outcomes among patients with DUA-IE versus non-DUA-IE, but current studies suffer selection bias. The utilization of OPAT for DUA-IE more generally is not well studied. Methods This retrospective cohort study compared OPAT use for DUA-IE versus non-DUA-IE in adults hospitalized between January 1, 2015 and September 1, 2019 at 3 urban hospitals. We used multivariable regression analysis to assess the association between DUA-IE and discharge with OPAT, adjusting for clinically significant covariables. Results The cohort included 518 patients (126 DUA-IE, 392 non-DUA-IE). Compared to those with non-DUA-IE, DUA-IE patients were younger (53.0 vs 68.2 years, P < .001) and more commonly undomiciled (9.5% vs 0.3%, P < .01). Patients with DUA-IE had a significantly lower odds of discharge with OPAT than non-DUA-IE patients (adjusted odds ratio [aOR] = 0.20; 95% confidence interval [CI], 0.10–0.39). Odds of discharge with OPAT remained lower for patients with DUA-IE after excluding undomiciled patients (aOR = 0.22; 95% CI, 0.11–0.43) and those with patient-directed discharges (aOR = 0.27; 95% CI, 0.14–0.52). Conclusions Significantly fewer patients with DUA-IE were discharged with OPAT compared to those with non-DUA-IE, and undomiciled patients or patient-directed discharges did not fully account for this difference. Efforts to increase OPAT utilization among patients with DUA-IE could have important benefits for patients and the healthcare system.
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Affiliation(s)
- Ashley G Ceniceros
- Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Nupur Shridhar
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Melissa Fazzari
- Department of Epidemiology & Population Health (Biostatistics), Albert Einstein College of Medicine, Bronx, New York, USA
| | - Uriel Felsen
- Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Aaron D Fox
- Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
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Farmer ECW, Seaton RA. Recent innovations and new applications of outpatient parenteral antimicrobial therapy. Expert Rev Anti Infect Ther 2020; 19:55-64. [PMID: 32799577 DOI: 10.1080/14787210.2020.1810566] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Outpatient parenteral antimicrobial therapy (OPAT) is safe and effective for selected patients managed within an organized clinical service. Service configurations however are evolving, patient populations are changing and new evidence is emerging which challenges traditional OPAT practice. AREAS COVERED This review will discuss evolving OPAT service delivery from the traditional model of infusion center toward nonspecialist, community and remotely delivered OPAT and the challenges this represents. We consider new patient populations including those with incurable infection or infections at the end of life and difficult to reach populations including people who inject drugs. The evidence base that underpins the multi-disciplinary approach to OPAT delivery will be examined and particularly the role of the antimicrobial pharmacist and specialist nurse. Evidence for new treatment options which challenge established OPAT practice including complex oral antibiotic regimens, long acting parenteral agents and drug stability in continuous infusion antibiotics will be considered. Finally we emphasize the central importance of antimicrobial stewardship and good clinical governance which should underpin OPAT practice. EXPERT OPINION Changing patient populations, service structures and team roles coupled with a growing infection management evidence base means that OPAT services and practice must evolve. Challenging traditional practice is essential to ensure best patient outcomes and cost-efficiency.
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Affiliation(s)
| | - Ronald Andrew Seaton
- Infectious Disease Department, Queen Elizabeth University Hospital , Glasgow, UK
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Ahiskali A, Rhodes H. Oritavancin for the treatment of complicated gram-positive infection in persons who inject drugs. BMC Pharmacol Toxicol 2020; 21:73. [PMID: 33115540 PMCID: PMC7594421 DOI: 10.1186/s40360-020-00452-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 10/08/2020] [Indexed: 12/18/2022] Open
Abstract
Background Treatment of complicated infections in persons who inject drugs (PWID) and patients experiencing homelessness poses a unique challenge to clinicians. Long-acting lipoglycopeptide antibiotics, such as oritavancin, may facilitate extended courses of outpatient intravenous therapy while avoiding the need for central lines, improving compliance and thus increasing the chance of clinical cure. Methods Retrospective chart review of adult PWID who received at least one dose of oritavancin for a gram-positive infection between 1/1/17 and 6/30/19 at a large safety net hospital. Results Twenty three PWID received 24 courses of at least one dose of oritavancin for a gram-positive infection; 16 were experiencing homelessness at the time of diagnosis. Methicillin resistant Staphylococcus aureus (MRSA) was the most common infecting pathogen and bone or joint the most frequent infection site. Nineteen encounters resulted in clinical cure, including 5 whose conditions improved despite non-adherence to their prescribed regimen. Three patients experienced a non-favorable outcome. Two patients experienced mild adverse drug reactions that did not interfere with therapy; no patients died while on therapy. Conclusion Oritavancin may be a clinically effective treatment option for the management of complicated gram-positive infections in PWID and patients experiencing homelessness. Further studies should be performed to validate these results.
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Affiliation(s)
- Aileen Ahiskali
- Department of Pharmacy, Hennepin Healthcare, 701 Park Avenue, Minneapolis, MN, 55415, USA
| | - Heather Rhodes
- Clinical Quality Improvement, Hennepin Healthcare, Orange 1.220-7, 701 Park Avenue, Minneapolis, MN, 55415, USA.
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