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Gamell A, Velasco-Arnaiz E, López-Ramos MG, Ríos-Barnés M, Simó-Nebot S, Fumadó V, Noguera-Julián A, Fortuny C. Off-label use of dalbavancin in children: a case series. J Antimicrob Chemother 2024:dkae212. [PMID: 38958260 DOI: 10.1093/jac/dkae212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 06/06/2024] [Indexed: 07/04/2024] Open
Abstract
INTRODUCTION Dalbavancin is an antibiotic active against most Gram-positive bacteria approved for acute bacterial skin and skin structure infections (ABSSSI). Owing to its long half-life, it is being increasingly used for other indications. PATIENTS AND METHODS We present a case series of children and adolescents treated with dalbavancin for osteoarticular, catheter-related and other non-ABSSSI infections. RESULTS Dalbavancin was prescribed to 15 patients. Six (40%) were female and median age at prescription was 11.9 (IQR 1.3-18.0) years. Most of them (12/15) had significant comorbidities. Patients presented mainly with deep surgical site infections, osteoarticular infections and central-line-associated bloodstream infections. The most common isolate was Staphylococcus aureus followed by Staphylococcus epidermidis. Major reasons to prescribe dalbavancin were to ensure compliance and patients' convenience. Two patients discontinued the drug due to adverse events possibly related to it. The rest of the patients completed the treatment with dalbavancin, with a median duration of 56 days (IQR 17.5, 115.5). All achieved complete resolution and present no relapse after a median follow-up of 9.9 months (IQR 4.8, 16.6). CONCLUSIONS Dalbavancin was a safe, effective and convenient alternative in selected paediatric patients with complicated non-ABSSSI infections caused by Gram-positive bacteria.
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Affiliation(s)
- Anna Gamell
- Infectious Diseases Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | | | | | - María Ríos-Barnés
- Infectious Diseases Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Sílvia Simó-Nebot
- Infectious Diseases Department, Hospital Sant Joan de Déu, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Victoria Fumadó
- Infectious Diseases Department, Hospital Sant Joan de Déu, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Paediatrics, University of Barcelona, Barcelona, Spain
| | - Antoni Noguera-Julián
- Infectious Diseases Department, Hospital Sant Joan de Déu, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Paediatrics, University of Barcelona, Barcelona, Spain
- Red de Investigación Translacional en Infectología Pediátrica (RITIP), Madrid, Spain
| | - Clàudia Fortuny
- Infectious Diseases Department, Hospital Sant Joan de Déu, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Paediatrics, University of Barcelona, Barcelona, Spain
- Red de Investigación Translacional en Infectología Pediátrica (RITIP), Madrid, Spain
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Garbo V, Condemi A, Albano C, Polara VF, Parrino R, Macaluso A, Venuti L, Colomba C. Dalbavancin for the treatment of acute bacterial skin and skin structure infections (ABSSSI) in pediatric patients: a case series. LE INFEZIONI IN MEDICINA 2024; 32:231-240. [PMID: 38827834 PMCID: PMC11142406 DOI: 10.53854/liim-3202-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 05/07/2024] [Indexed: 06/05/2024]
Abstract
Acute bacterial skin and skin-structure infections (ABSSSI) are a significant cause of morbidity in pediatric patients, requiring timely and effective treatment. Dalbavancin, a long-acting lipoglycopeptide antibiotic recently approved for pediatric use, offers advantages such as excellent bactericidal activity against Gram-positive bacteria (including multidrug-resistant pathogens) and high tissue penetration. We present a case series of pediatric patients with ABSSSI treated with dalbavancin. Five cases were described demonstrating the efficacy of dalbavancin in different clinical scenarios. Patients with complex skin conditions, including cellulitis and deep abscesses, benefited from dalbavancin therapy, achieving significant clinical improvement. Notably, dalbavancin facilitated early discharge, improving quality of life and reducing healthcare costs. These cases highlight the potential of dalbavancin as a valuable treatment option for ABSSSI in pediatric patients, particularly in settings where conventional therapies fail to achieve optimal clinical outcomes or prolonged hospitalization is not feasible. Further research is needed to clarify its role and optimize its use in pediatric patients with ABSSSI.
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Affiliation(s)
- Valeria Garbo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, Palermo,
Italy
- Division of Paediatric Infectious Disease, “G. Di Cristina” Hospital, ARNAS Civico Di Cristina Benfratelli, Palermo,
Italy
| | - Anna Condemi
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, Palermo,
Italy
- Division of Paediatric Infectious Disease, “G. Di Cristina” Hospital, ARNAS Civico Di Cristina Benfratelli, Palermo,
Italy
| | - Chiara Albano
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, Palermo,
Italy
| | - Valentina Frasca Polara
- Division of Paediatric Infectious Disease, “G. Di Cristina” Hospital, ARNAS Civico Di Cristina Benfratelli, Palermo,
Italy
| | - Roberta Parrino
- Division of Paediatric Infectious Disease, “G. Di Cristina” Hospital, ARNAS Civico Di Cristina Benfratelli, Palermo,
Italy
| | - Alessandra Macaluso
- Division of Paediatric Infectious Disease, “G. Di Cristina” Hospital, ARNAS Civico Di Cristina Benfratelli, Palermo,
Italy
| | - Laura Venuti
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, Palermo,
Italy
| | - Claudia Colomba
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, Palermo,
Italy
- Division of Paediatric Infectious Disease, “G. Di Cristina” Hospital, ARNAS Civico Di Cristina Benfratelli, Palermo,
Italy
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Caselli D, Mariani M, Colomba C, Ferrecchi C, Cafagno C, Trotta D, Carloni I, Dibello D, Castagnola E, Aricò M. Real-World Use of Dalbavancin for Treatment of Soft Tissue and Bone Infection in Children: Safe, Effective and Hospital-Time Sparing. CHILDREN (BASEL, SWITZERLAND) 2024; 11:78. [PMID: 38255391 PMCID: PMC10814822 DOI: 10.3390/children11010078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 01/24/2024]
Abstract
Acute bacterial skin and skin structure infections (ABSSSI) and osteoarticular infections compound the burden of morbidity, mortality and prolonged hospitalizations among gram-positive infections. Dalbavancin, a second-generation, intravenous lipoglycopeptide, due to its prolonged half-life, can be a valuable alternative in their treatment when administered as inpatient treatment at the price of an extended hospital stay. Between October 2019 and September 2023, 31 children and adolescents were treated with dalbavancin because of bone and joint infections (n = 12 patients, 39%), ABSSSI (n = 13 patients, 42%), mainly for the limbs, facial cellulitis or complicated ABSSSI (n = 6 patients, 19%), at five Italian pediatric centers. Microbiological study provided gram-positive bacterial isolate in 16 cases, in 11 cases from a positive blood culture; 9 of them were MRSA. Twenty-five patients were initially treated with a different antibiotic therapy: beta-lactam-based in 18 patients (58%), glycopeptide-based in 15 patients (48%) and daptomycin in 6 (19%). The median time that elapsed between admission and start of dalbavancin was 18 days. A total of 61 doses of dalbavancin were administered to the 31 patients: 16 received a single dose while the remaining 15 patients received between two (n = 9) and nine doses. The frequency of administration was weekly in five cases or fortnightly in nine patients. Median length of stay in hospital was 16 days. Median time to discharge after the first dose of dalbavancin was 1 day. Treatment was very well-tolerated: of the 61 administered doses, only four doses, administered to four patients, were associated with an adverse event: drug extravasation during intravenous administration occurred in two patients, with no sequelae; however, in two patients the first administration was stopped soon after infusion start: in one (ID #11), due to headache and vomiting; in another (ID #12) due to a systemic reaction. In both patients, drug infusion was not repeated. None of the remaining 29 patients reported treatment failure (resistant or recurrent disease) or an adverse effect during a median follow-up time of two months. The use of dalbavancin was safe, feasible and also effective in shortening the hospital stay in children and adolescents.
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Affiliation(s)
- Désirée Caselli
- Infectious Diseases, Children’s Hospital Giovanni XXIII, Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari, 70124 Bari, Italy; (D.C.); (C.C.)
| | - Marcello Mariani
- Pediatrics and Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Claudia Colomba
- Department of Health Promotion, Maternal and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90133 Palermo, Italy;
- Division of Pediatric Infectious Diseases, “G. Di Cristina” Hospital, ARNAS Civico Di Cristina Benfratelli, 90127 Palermo, Italy
| | - Chiara Ferrecchi
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Sciences (DINOGMI), University of Genoa, 16126 Genoa, Italy;
| | - Claudio Cafagno
- Infectious Diseases, Children’s Hospital Giovanni XXIII, Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari, 70124 Bari, Italy; (D.C.); (C.C.)
| | - Daniela Trotta
- Pediatrics, S. Spirito Hospital, A.S.L. Pescara, 65124 Pescara, Italy; (D.T.); (M.A.)
| | - Ines Carloni
- Department of Mother and Child Health, Salesi Children’s Hospital, 60123 Ancona, Italy;
| | - Daniela Dibello
- Pediatric Orthopedics and Traumatology, Children’s Hospital Giovanni XXIII, 70125 Bari, Italy;
| | - Elio Castagnola
- Pediatrics and Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Maurizio Aricò
- Pediatrics, S. Spirito Hospital, A.S.L. Pescara, 65124 Pescara, Italy; (D.T.); (M.A.)
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Poggi C, Dani C. New Antimicrobials for the Treatment of Neonatal Sepsis Caused by Multi-Drug-Resistant Bacteria: A Systematic Review. Antibiotics (Basel) 2023; 12:956. [PMID: 37370275 DOI: 10.3390/antibiotics12060956] [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: 04/30/2023] [Revised: 05/19/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Infections by multi-drug-resistant (MDR) organisms are sharply increasing in newborns worldwide. In low and middle-income countries, a disproportionate amount of neonatal sepsis caused by MDR Gram negatives was recently reported. Newborns with infections by MDR organisms with limited treatment options may benefit from novel antimicrobials. METHODS We performed a literature search investigating the use in newborns, infants and children of novel antimicrobials for the treatment of MDR Gram negatives, namely ceftazidime/avibactam, ceftolozane/tazobactam, cefiderocol, meropenem/vaborbactam, imipenem/relebactam, and Gram positives with resistance of concern, namely ceftaroline and dalbavancin. PubMed, EMBASE, and Web of Science were searched. RESULTS A total of 50 records fulfilled the inclusion criteria. Most articles were case reports or case series, and ceftazidime/avibactam was the most studied agent. All studies showed favorable efficacy and safety profile in newborns and across different age cohorts. CONCLUSIONS novel antibiotics may be considered in newborns for the treatment of MDR Gram negatives with limited treatment options and for Gram positives with resistance concerns. Further studies are needed to address their effectiveness and safety in newborns.
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Affiliation(s)
- Chiara Poggi
- Neonatal Intensive Care Unit, Department of Mother and Child Care, Careggi University Hospital, 50141 Florence, Italy
| | - Carlo Dani
- Neonatal Intensive Care Unit, Department of Mother and Child Care, Careggi University Hospital, 50141 Florence, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50141 Florence, Italy
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Volpicelli L, Venditti M, Oliva A. Acute bacterial skin and skin structure infections in pediatric patients: potential role of dalbavancin. Expert Rev Anti Infect Ther 2023; 21:329-341. [PMID: 36803139 DOI: 10.1080/14787210.2023.2182769] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
INTRODUCTION Acute bacterial skin and skin structure infections (ABSSSIs) are a subtype of skin and soft tissue infections (SSTI), usually sustained by Gram-positive bacteria, whose incidence is high among children. ABSSSIs are responsible for a considerable number of hospitalizations. Moreover, as multidrug resistant (MDR) pathogens become widespread, the pediatric category seems burdened with an increased risk of resistance and treatment failure. AREAS COVERED To obtain a view on the status of the field, we describe the clinical, epidemiological, and microbiological aspects of ABSSSI in children. Old and new treatment options were critically revised with a focus on the pharmacological characteristics of dalbavancin. Evidence on the use of dalbavancin in children was collected, analyzed, and summarized. EXPERT OPINION Many of the therapeutic options available at the moment are characterized by the need for hospitalization or repeated intravenous infusions, safety issues, possible drug-drug interactions, and reduced efficacy on MDRs. Dalbavancin, the first long-acting molecule with strong activity against methicillin-resistant and also many vancomycin-resistant pathogens represents a game changer for adult ABSSSI. In pediatric settings, the available literature is still limited, but a growing body of evidence supports dalbavancin use in children with ABSSSI, demonstrating this drug to be safe and highly efficacious.
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Affiliation(s)
- Lorenzo Volpicelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome Roma, Italy
| | - Mario Venditti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome Roma, Italy
| | - Alessandra Oliva
- Department of Public Health and Infectious Diseases, Sapienza University of Rome Roma, Italy
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Rallis D, Giapros V, Serbis A, Kosmeri C, Baltogianni M. Fighting Antimicrobial Resistance in Neonatal Intensive Care Units: Rational Use of Antibiotics in Neonatal Sepsis. Antibiotics (Basel) 2023; 12:antibiotics12030508. [PMID: 36978375 PMCID: PMC10044400 DOI: 10.3390/antibiotics12030508] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/26/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
Antibiotics are the most frequently prescribed drugs in neonatal intensive care units (NICUs) due to the severity of complications accompanying neonatal sepsis. However, antimicrobial drugs are often used inappropriately due to the difficulties in diagnosing sepsis in the neonatal population. The reckless use of antibiotics leads to the development of resistant strains, rendering multidrug-resistant pathogens a serious problem in NICUs and a global threat to public health. The aim of this narrative review is to provide a brief overview of neonatal sepsis and an update on the data regarding indications for antimicrobial therapy initiation, current guidance in the empirical antimicrobial selection and duration of therapy, and indications for early discontinuation.
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Affiliation(s)
- Dimitrios Rallis
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, 451 10 Ioannina, Greece
| | - Vasileios Giapros
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, 451 10 Ioannina, Greece
- Correspondence: ; Tel.: +30-(26)-51099326
| | - Anastasios Serbis
- Department of Paediatrics, School of Medicine, University of Ioannina, 451 10 Ioannina, Greece
| | - Chrysoula Kosmeri
- Department of Paediatrics, School of Medicine, University of Ioannina, 451 10 Ioannina, Greece
| | - Maria Baltogianni
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, 451 10 Ioannina, Greece
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