Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy.
Cardiothoracic and Vascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, RA, Italy.
J Glob Antimicrob Resist. 2019 Sep;18:195-198. doi: 10.1016/j.jgar.2019.03.015. Epub 2019 Mar 27.
Deep sternal wound infection (DSWI) is a complication of major heart surgery with high morbidity as well as prolonged antimicrobial treatment and hospital length of stay (LoS). Dalbavancin is a new lipoglycopeptide antibiotic active against Gram-positive micro-organisms, including methicillin-resistant Staphylococcus aureus (MRSA), with a long half-life. This small case series assessed the feasibility of dalbavancin for the treatment of DSWI.
This was retrospective, observational, cohort study of patients treated with dalbavancin for DSWI over a 2-year period (March 2016 to April 2018) in two cardiac surgery departments in Italy. All patients with DSWI underwent surgical accurate debridement. Dalbavancin was administered during the hospital stay or in an outpatient facility.
Among 15 patients enrolled in the study, MRSA was isolated in 7 (47%), methicillin-resistant Staphylococcus epidermidis in 6 (40%) and other coagulase-negative staphylococci in 2 (13%). Dalbavancin was administered by two infusions in 9 patients (60%), whereas 5 patients (33%) received a median of four doses. Fourteen patients received a first dose of 1000mg followed by 500mg, whereas one patient received two doses of 1500mg each. All patients were defined as clinically cured. The median hospital LoS was 13 days (interquartile range, 8-18 days). At 6 months after discharge, 14 patients (93%) showed no relapse of DSWI, whereas 1 patient recurred with a diagnosis of DSWI caused by another pathogen (Candida sp.).
Dalbavancin may be an alternative option for DSWI caused by Gram-positive bacteria when first-line treatments are contraindicated or as salvage treatment.
深部胸骨伤口感染（DSWI）是心脏大手术的一种并发症，具有较高的发病率，需要长时间的抗菌治疗和住院时间（LoS）。达巴万星是一种新型糖肽类抗生素，对包括耐甲氧西林金黄色葡萄球菌（MRSA）在内的革兰氏阳性微生物具有活性，半衰期长。本小型病例系列评估了达巴万星治疗 DSWI 的可行性。
这是一项回顾性、观察性、队列研究，纳入了 2016 年 3 月至 2018 年 4 月在意大利两个心脏外科部门接受达巴万星治疗 DSWI 的患者。所有 DSWI 患者均接受了手术清创术。达巴万星在住院期间或门诊进行治疗。
在纳入研究的 15 名患者中，7 名（47%）患者分离出 MRSA，6 名（40%）患者分离出耐甲氧西林表皮葡萄球菌，2 名（13%）患者分离出其他凝固酶阴性葡萄球菌。9 名（60%）患者接受了两次输注，5 名（33%）患者接受了 4 次剂量中位数。14 名患者接受了首次 1000mg 剂量，随后是 500mg，而 1 名患者接受了两次 1500mg 剂量。所有患者均被定义为临床治愈。中位住院时间为 13 天（四分位距 8-18 天）。出院后 6 个月时，14 名患者（93%）未出现 DSWI 复发，1 名患者复发，诊断为另一种病原体（念珠菌属）引起的 DSWI。
当一线治疗禁忌或作为挽救治疗时，达巴万星可能是革兰氏阳性菌引起的 DSWI 的另一种选择。
