比较达巴万星与标准护理在门诊治疗侵袭性革兰阳性感染中的疗效。
Comparison of dalbavancin to standard-of-care for outpatient treatment of invasive Gram-positive infections.
机构信息
Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, Knoxville, TN, 37920, USA; Department of Pharmacy, University of Tennessee Medical Center, Knoxville, TN, 37920, USA.
Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California at San Diego, La Jolla, CA 92093, USA.
出版信息
Int J Antimicrob Agents. 2020 Dec;56(6):106210. doi: 10.1016/j.ijantimicag.2020.106210. Epub 2020 Oct 23.
OBJECTIVE
To assess the efficacy and safety of dalbavancin compared to standard-of-care (SOC) or vancomycin and daptomycin in invasive infections due to suspected or confirmed Gram-positive organisms.
METHODS
Retrospective cohort of adults who received dalbavancin or SOC on discharge or as an outpatient from 12/2016 to 11/2019. Indications were osteoarticular infection (OAI), infective endocarditis (IE), or other bloodstream infection (BSI). Primary endpoint was 90-day infection-related readmission (IRR); secondary endpoints included time-to-IRR, frequency of adverse drug events (ADEs), and all-cause readmission and mortality.
RESULTS
215 patients were included: 70 (33%) receiving dalbavancin, and 145 (67%) receiving SOC. Indications were OAI (47%), IE (27%), and other BSI (26%). OAI was more common in patients on dalbavancin compared with those receiving SOC (70% vs. 37%, P<0.001). Dalbavancin patients had shorter median (interquartile range [IQR]) length of stay (LOS) prior to drug initiation compared with those receiving SOC (10 [7-17] vs. 13 [9-19], P=0.021). IRR incidence was 17% for dalbavancin patients and 28% for SOC patients. Dalbavancin use was independently associated with lower IRR (adjusted odds ratio [adjOR], 0.10; 95% confidence interval [CI], 0.04-0.31). There was longer median (IQR) time-to-IRR in the dalbavancin group (43 [30-87] vs. 23 [11-63] days, P=0.039), but no differences in all-cause readmission or mortality. Treatment-related ADE incidence was 3% and 14% for the dalbavancin and SOC groups, respectively (P=0.013). Infusion reactions (1/2) and catheter-related complications (1/2) were the most common dalbavancin ADEs; catheter-related complications (14/21), nephrotoxicity (3/21), rhabdomyolysis (2/21), and rash (2/21) were the most common SOC ADEs.
CONCLUSIONS
Dalbavancin use was associated with lower 90-day IRR, a shorter hospital LOS prior to therapy, and longer time-to-IRR compared with SOC.
目的
评估达巴万星与标准治疗（SOC）或万古霉素和达托霉素在疑似或确诊革兰阳性菌引起的侵袭性感染中的疗效和安全性。
方法
回顾性队列研究纳入了 2016 年 12 月至 2019 年 11 月期间因骨关节炎感染（OAI）、感染性心内膜炎（IE）或其他血流感染（BSI）而接受达巴万星或 SOC 出院或门诊治疗的成年人。主要终点为 90 天与感染相关的再入院（IRR）；次要终点包括 IRR 时间、药物不良事件（ADE）发生率以及全因再入院和死亡率。
结果
共纳入 215 例患者：70 例（33%）接受达巴万星治疗，145 例（67%）接受 SOC 治疗。适应症为 OAI（47%）、IE（27%）和其他 BSI（26%）。与接受 SOC 治疗的患者相比，接受达巴万星治疗的患者 OAI 更为常见（70% vs. 37%，P<0.001）。与接受 SOC 治疗的患者相比，接受达巴万星治疗的患者在开始药物治疗前的中位（四分位距 [IQR]）住院时间更短（10 [7-17] 与 13 [9-19]，P=0.021）。达巴万星组和 SOC 组的 IRR 发生率分别为 17%和 28%。达巴万星的使用与较低的 IRR 独立相关（校正优势比 [adjOR]，0.10；95%置信区间 [CI]，0.04-0.31）。达巴万星组的中位（IQR）IRR 时间更长（43 [30-87] 与 23 [11-63] 天，P=0.039），但全因再入院或死亡率无差异。达巴万星组和 SOC 组的治疗相关 ADE 发生率分别为 3%和 14%（P=0.013）。达巴万星组最常见的 ADE 为输液反应（1/2）和导管相关并发症（1/2）；SOC 组最常见的 ADE 为导管相关并发症（14/21）、肾毒性（3/21）、横纹肌溶解症（2/21）和皮疹（2/21）。
结论
与 SOC 相比，达巴万星治疗与 90 天 IRR 降低、治疗前住院时间缩短和 IRR 时间延长相关。
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