John D. Archbold Memorial Hospital, Thomasville, GA, USA.
Division of Infectious Diseases, University of Colorado, Aurora, CO, USA.
Int J Antimicrob Agents. 2020 Sep;56(3):106069. doi: 10.1016/j.ijantimicag.2020.106069. Epub 2020 Jun 27.
There is increasing interest in the use of oritavancin and dalbavancin for complicated Gram-positive infections as an alternative to in-hospital intravenous or outpatient antimicrobial therapy.
To evaluate the efficacy and safety of long-acting lipoglycopeptides (laLGPs) in patients with osteoarticular, cardiovascular, intravascular-catheter-related and other complicated infections.
A systematic literature search was performed using 'dalbavancin' and 'oritavancin' as search terms. For inclusion in this review, studies had to include at least one human subject treated for an indication other than acute bacterial skin and skin structure infections. The primary outcome for this review was clinical success as defined by each individual study, and patients were stratified by type of infection.
In total, 38 studies (18 randomized controlled trials/case series and 20 case reports) met the inclusion criteria. The most common off-label indication for oritavancin and dalbavancin was osteoarticular infection, with a median success rate of 73% [interquartile range (IQR) 58-85%] among the 14 studies with more than one patient. The success rate for endocarditis and cardiac-device-related infections was 68% (IQR 56-86%) among nine studies, and the success rate for catheter-related bloodstream infection was 75% (IQR 59-90%) among seven studies. Among the 16 studies of almost 700 patients receiving laLGPs, there were 98 reports of adverse events, resulting in 13% of treated patients reporting an event.
This review provides evidence that laLGPs are safe and efficacious for osteoarticular, cardiovascular, intravascular-catheter-related and other complicated infections. Further research is needed to confirm these results.
越来越多的人对使用达托霉素和奥利万星治疗复杂的革兰氏阳性感染感兴趣，将其作为住院静脉或门诊抗菌治疗的替代方法。
评估长效糖肽类抗生素（laLGPs）在治疗骨关节炎、心血管、血管内导管相关和其他复杂感染患者中的疗效和安全性。
使用“达托霉素”和“奥利万星”作为检索词进行系统文献检索。纳入本综述的研究必须至少包括一名治疗非急性细菌性皮肤和皮肤结构感染适应证的人类受试者。本综述的主要结局是每个单独研究定义的临床疗效，并且根据感染类型对患者进行分层。
共有 38 项研究（18 项随机对照试验/病例系列研究和 20 项病例报告）符合纳入标准。骨关节炎感染是奥利万星和达托霉素最常见的适应证，14 项患者超过 1 例的研究中，中位成功率为 73%[四分位距（IQR）58%-85%]。9 项研究中，心内膜炎和心脏器械相关感染的成功率为 68%（IQR 56%-86%），7 项研究中，导管相关血流感染的成功率为 75%（IQR 59%-90%）。在接受 laLGPs 治疗的近 700 名患者的 16 项研究中，有 98 例不良反应报告，导致 13%的治疗患者报告发生了不良反应。
本综述提供了证据表明，laLGPs 对骨关节炎、心血管、血管内导管相关和其他复杂感染是安全有效的。需要进一步的研究来证实这些结果。
