Long-Term Suppressive Therapeutic-Drug-Monitoring-Guided Dalbavancin Therapy for Cardiovascular Prosthetic Infections
-
Published:2023-11-19
Issue:11
Volume:12
Page:1639
-
ISSN:2079-6382
-
Container-title:Antibiotics
-
language:en
-
Short-container-title:Antibiotics
Author:
Gallerani Altea1, Gatti Milo23ORCID, Bedini Andrea1ORCID, Casolari Stefania1, Orlando Gabriella1, Puzzolante Cinzia1ORCID, Franceschini Erica1ORCID, Menozzi Marianna1ORCID, Santoro Antonella1, Barp Nicole1ORCID, Volpi Sara1, Soffritti Alessandra1, Pea Federico23ORCID, Mussini Cristina1, Meschiari Marianna1ORCID
Affiliation:
1. Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy 2. Clinical Pharmacology Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy 3. Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
Abstract
Dalbavancin represents a promising treatment for cardiovascular prosthetic infections due to its prolonged half-life, bactericidal activity, large spectrum of activity, and excellent biofilm penetration. However, the use of dalbavancin in this setting is limited, and only a few cases have performed therapeutic drug monitoring (TDM) analysis to optimize dosage in suppressive treatments longer than 4 weeks. Our retrospective case series reports the use of dalbavancin in a small cohort of patients with cardiovascular prosthetic infections (cardiac implantable electronic device infections (CEDIs), prosthetic valve endocarditis (PVE), prosthetic vascular graft infections (PVGIs)) treated with dalbavancin as sequential therapy. From May 2019 to May 2023, 14 patients were included: eight cases of PVE (57.1%), seven cases of PVGI (50%), three cases of CEDI (21.4%), and four cases with overlap of infection sites (28.6%). The main pathogen was Staphylococcus aureus (35.7%). Prosthesis replacement was obtained in four patients (28.6%). The median time between symptom onset and the end of treatment was 15 weeks (IQR 7–53), with a median duration of dalbavancin therapy of 8 weeks (IQR 1 to 45 weeks) and 3.5 doses per patient. Among patients managed with TDM-guided strategy, dalbavancin infusion intervals ranged from 4 to 9 weeks. The median length of follow-up was 65 weeks (IQR 23 to 144 weeks). Clinical success was achieved in 10 cases (76.9%); all clinical failures occurred in patients with the implant retained. Among patients monitored by TDM, clinical success was 87.5% vs. 60% in patients treated without TDM. Because of pharmacokinetic individual variability, dalbavancin TDM-guided administration could improve clinical outcomes by individualizing dosing and selecting dosing intervals. This case series seems to suggest a promising role of long-term suppressive dalbavancin treatment for difficult-to-treat cardiovascular prosthesis infection, also with limited surgical indications.
Subject
Pharmacology (medical),Infectious Diseases,Microbiology (medical),General Pharmacology, Toxicology and Pharmaceutics,Biochemistry,Microbiology
Reference23 articles.
1. Cojutti, P.G., Tedeschi, S., Gatti, M., Zamparini, E., Meschiari, M., Siega, P.D., Mazzitelli, M., Soavi, L., Binazzi, R., and Erne, E.M. (2022). Population Pharmacokinetic and Pharmacodynamic Analysis of Dalbavancin for Long-Term Treatment of Subacute and/or Chronic Infectious Diseases: The Major Role of Therapeutic Drug Monitoring. Antibiotics, 11. 2. Real-world experience with dalbavancin therapy in gram-positive skin and soft tissue infection, bone and joint infection;Tobudic;Infection,2019 3. Epithelial Lining Fluid and Plasma Concentrations of Dalbavancin in Healthy Adults after a Single 1,500-Milligram Infusion;Rappo;Antimicrob. Agents Chemother.,2019 4. Population pharmacokinetic analysis of dalbavancin, a novel lipoglycopeptide;Buckwalter;J. Clin. Pharmacol.,2005 5. Extended-duration dosing and distribution of dalbavancin into bone and articular tissue;Dunne;Antimicrob. Agents Chemother.,2015
|
|