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Lafon-Desmurs B, Gachet B, Hennart B, Valentin B, Roosen G, Degrendel M, Loiez C, Beltrand E, D'Elia P, Migaud H, Robineau O, Senneville E. Dalbavancin as suppressive therapy for implant-related infections: a case series with therapeutic drug monitoring and review of the literature. Eur J Clin Microbiol Infect Dis 2024; 43:1475-1480. [PMID: 38753112 DOI: 10.1007/s10096-024-04849-0] [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: 12/21/2023] [Accepted: 05/07/2024] [Indexed: 07/20/2024]
Abstract
Implant-related infections may need suppressive antibiotic therapy (SAT). We describe a SAT strategy using dalbavancin with therapeutic drug monitoring (TDM). This is a retrospective bicentric study of patients with implant-related infection who received dalbavancin SAT between January 2021 and September 2023. Fifteen patients were included. Median number of injections was 4 (IQR: 2-7). Median time between two reinjections was 57 days (IQR 28-82). Dalbavancin plasma concentrations were above 4 mg/L for 97.9% of dosages (93/95) and above 8 mg/L for 85% (81/95). These results support the use of dalbavancin SAT for implant-related infections.
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Affiliation(s)
- Barthelemy Lafon-Desmurs
- Centre Hospitalier Gustave Dron, Department of Infectious Diseases, Service Universitaire Des Maladies Infectieuses, 59210, Tourcoing, France.
| | - Benoit Gachet
- Centre Hospitalier Gustave Dron, Department of Infectious Diseases, Service Universitaire Des Maladies Infectieuses, 59210, Tourcoing, France
- METRICS ULR 2694, Biostatistics, Lille, France
| | - Benjamin Hennart
- Lille University Hospital, Department of Pharmacology and Toxicology, Lille, France
| | - Benjamin Valentin
- Lille University Hospital, Department of Pharmacology, Lille, France
| | - Gabrielle Roosen
- Centre Hospitalier Gustave Dron, Department of Microbiology, Tourcoing, France
| | - Maxime Degrendel
- Centre Hospitalier Gustave Dron, Department of Infectious Diseases, Service Universitaire Des Maladies Infectieuses, 59210, Tourcoing, France
| | - Caroline Loiez
- Lille University Hospital, Department of Microbiology, Lille, France
| | - Eric Beltrand
- Centre Hospitalier Gustave Dron, Department of Orthopedic Surgery, Tourcoing, France
| | - Piervito D'Elia
- Centre Hospitalier Gustave Dron, Départment of Vascular Surgery, Tourcoing, France
| | - Henri Migaud
- Lille University Hospital, Department of Orthopedic Surgery, Lille, France
| | - Olivier Robineau
- Centre Hospitalier Gustave Dron, Department of Infectious Diseases, Service Universitaire Des Maladies Infectieuses, 59210, Tourcoing, France
- METRICS ULR 2694, Biostatistics, Lille, France
- INSERM UMR-S 1136, Institut Pierre Louis d'Epidémiologie Et de Santé Publique, Paris, France
| | - Eric Senneville
- Centre Hospitalier Gustave Dron, Department of Infectious Diseases, Service Universitaire Des Maladies Infectieuses, 59210, Tourcoing, France
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Pallotto C, Tommasi A, Albagini M, Genga G, Svizzeretto E, Gidari A, Tordi S, Francisci D. Chronic antibiotic suppressive therapy with dalbavancin: a case series. J Chemother 2024:1-5. [PMID: 38712995 DOI: 10.1080/1120009x.2024.2349442] [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: 01/12/2024] [Accepted: 04/24/2024] [Indexed: 05/08/2024]
Abstract
Dalbavancin is a relatively new long-acting anti-Gram positive antimicrobial approved for the treatment of acute bacterial skin and skin structures infections. An increasing number of observational studies and case series were published on its off-label uses. Great interest is emerging about complicated cases where antibiotic treatment cannot be discontinued, and a chronic suppressive therapy is needed. We described a case series of 6 patients treated or ongoing on treatment with dalbavancin as chronic suppressive therapy (CAST) administered with the following regimen: dalbavancin 1500 mg on day 1 and 8 and then every 4 weeks. CAST median duration was 27 weeks. Five out of 6 patients reached a good clinical control of the infection (one of them completely resolved) while in one case we observed a recurrence of the infection. No adverse events were detected. Larger studies are needed to better clarify dalbavancin off-label uses and the most appropriate dose regimen.
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Affiliation(s)
- Carlo Pallotto
- Infectious Diseases Clinic, Santa Maria della Misericordia Hospital, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Andrea Tommasi
- Infectious Diseases Clinic, Santa Maria della Misericordia Hospital, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Margherita Albagini
- Infectious Diseases Clinic, Santa Maria della Misericordia Hospital, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Giovanni Genga
- Infectious Diseases Clinic, Santa Maria della Misericordia Hospital, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Elisabetta Svizzeretto
- Infectious Diseases Clinic, Santa Maria della Misericordia Hospital, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Anna Gidari
- Infectious Diseases Unit, Santa Maria Hospital, Department of Medicine and Surgery, University of Perugia, Terni, Italy
| | - Sara Tordi
- Infectious Diseases Clinic, Santa Maria della Misericordia Hospital, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Daniela Francisci
- Infectious Diseases Clinic, Santa Maria della Misericordia Hospital, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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Cattaneo D, Fusi M, Colaneri M, Fusetti C, Genovese C, Giorgi R, Matone M, Merli S, Petri F, Gori A. Therapeutic Drug Monitoring of Dalbavancin in Real Life: A Two-Year Experience. Antibiotics (Basel) 2023; 13:20. [PMID: 38247579 PMCID: PMC10812767 DOI: 10.3390/antibiotics13010020] [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: 11/17/2023] [Revised: 12/22/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024] Open
Abstract
Dalbavancin is a long-acting lipoglycopeptide that is registered for the treatment of acute bacterial skin and skin structure infections, and it is also increasingly used for infections that require prolonged antibiotic treatment. Here, we present the results from the first 2 years of a service set up in December 2021 for the therapeutic drug monitoring (TDM) of dalbavancin in clinical settings. In particular, we compared the trough concentration (Cmin) to maximum concentration (Cmax) in patients with osteoarticular infections receiving prolonged treatment with dalbavancin. Log-linear regression models were used to estimate the timing of dalbavancin administration with the goal of maintaining Cmin concentrations of >8 mg/L in the two TDM-based strategies. From December 2021 to November 2023, 366 TDMs of dalbavancin from 81 patients were performed. The Cmin and Cmax concentrations of dalbavancin ranged from 4.1 to 70.5 mg/L and from 74.9 to 995.6 mg/L, respectively. With log-linear regression models, we estimated that each injection should be administered every 42-48 days to maintain the Cmin concentrations. Out of the 81 patients, 37 received at least three doses of dalbavancin for the treatment of osteoarticular infections. Despite there being no significant differences in the days of dalbavancin treatment (130 ± 97 versus 106 ± 102 days), the patients in the Cmax-based TDM group received a significantly lower number of dalbavancin injections (5.2 ± 1.8 versus 7.3 ± 2.6 injections, p = 0.005), and they were administered over a longer period of time (40 ± 10 versus 29 ± 14 days, p = 0.013) than in the Cmin-based TDM group. In conclusion, Cmax-based TDM was associated with a significant reduction in the inter-individual variability of dalbavancin concentrations and lower drug dosing frequency than those of Cmin-based TDM. This approach could, therefore, favor a more rational and targeted use of dalbavancin in patients requiring prolonged treatment.
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Affiliation(s)
- Dario Cattaneo
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco University Hospital, 20157 Milan, Italy; (M.C.); (C.F.); (C.G.); (R.G.); (M.M.); (S.M.); (F.P.); (A.G.)
| | - Marta Fusi
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy;
| | - Marta Colaneri
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco University Hospital, 20157 Milan, Italy; (M.C.); (C.F.); (C.G.); (R.G.); (M.M.); (S.M.); (F.P.); (A.G.)
| | - Chiara Fusetti
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco University Hospital, 20157 Milan, Italy; (M.C.); (C.F.); (C.G.); (R.G.); (M.M.); (S.M.); (F.P.); (A.G.)
| | - Camilla Genovese
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco University Hospital, 20157 Milan, Italy; (M.C.); (C.F.); (C.G.); (R.G.); (M.M.); (S.M.); (F.P.); (A.G.)
| | - Riccardo Giorgi
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco University Hospital, 20157 Milan, Italy; (M.C.); (C.F.); (C.G.); (R.G.); (M.M.); (S.M.); (F.P.); (A.G.)
| | - Maddalena Matone
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco University Hospital, 20157 Milan, Italy; (M.C.); (C.F.); (C.G.); (R.G.); (M.M.); (S.M.); (F.P.); (A.G.)
| | - Stefania Merli
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco University Hospital, 20157 Milan, Italy; (M.C.); (C.F.); (C.G.); (R.G.); (M.M.); (S.M.); (F.P.); (A.G.)
| | - Francesco Petri
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco University Hospital, 20157 Milan, Italy; (M.C.); (C.F.); (C.G.); (R.G.); (M.M.); (S.M.); (F.P.); (A.G.)
| | - Andrea Gori
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco University Hospital, 20157 Milan, Italy; (M.C.); (C.F.); (C.G.); (R.G.); (M.M.); (S.M.); (F.P.); (A.G.)
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy;
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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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