Molina Kyle C, Lunowa Cali, Lebin Madelyn, Segerstrom Nunez Andrea, Azimi Sara F, Krsak Martin, Mueller Scott W, Miller Matthew A
Department of Pharmacy, University of Colorado Hospital, Aurora, Colorado, USA.
Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado, USA.
Open Forum Infect Dis. 2022 Jul 14;9(7):ofac335. doi: 10.1093/ofid/ofac335. eCollection 2022 Jul.
Dalbavancin (DAL) is a long-acting lipoglycopeptide with activity against including methicillin-resistant (MRSA). This study investigates DAL as sequential therapy in bloodstream infections (BSIs).
We conducted a retrospective cohort study from 2014 to 2021 comparing sequential DAL with standard-of-care therapy (SoC) for BSI. The primary outcome was 90-day clinical failure (90-day all-cause mortality or 90-day recurrence). Secondary outcomes were incidence of acute kidney injury, creatinine phosphokinase elevations, catheter-related thrombosis, and hospital-acquired infections. Analyses were adjusted using inverse probability of treatment weighting (IPTW).
Overall, 225 patients (45 DAL, 180 SoC) were included. DAL patients had a higher incidence of community-acquired infection and persons who use drugs; SoC patients had more comorbidities and a longer duration of bacteremia. MRSA incidence was similar between the DAL and SoC groups. The median length of stay was 16 days among DAL recipients compared with 24 days among SoC recipients. Central catheter placement was 17.8% compared with 57.2% in the SoC group. Ninety-day clinical failure occurred in 13.3% and 18.3% of participants in the DAL and SOC groups, respectively. In IPTW-adjusted analysis, sequential DAL was not associated with 90-day clinical failure (adjusted odds ratio, 0.94; 95% CI, 0.333-2.32).
This study provides preliminary evidence that select patients with BSI treated with sequential DAL have similar clinical failure rates, with significant reductions in catheter placement and hospital length of stay compared with SoC. Further prospective evaluation is needed.
达巴万星（DAL）是一种长效脂糖肽，对包括耐甲氧西林金黄色葡萄球菌（MRSA）在内的多种细菌具有活性。本研究调查达巴万星作为血流感染（BSI）序贯治疗的效果。
我们进行了一项回顾性队列研究，比较2014年至2021年期间达巴万星序贯治疗与标准治疗（SoC）用于BSI的情况。主要结局是90天临床失败（90天全因死亡率或90天复发率）。次要结局包括急性肾损伤、肌酐磷酸激酶升高、导管相关血栓形成和医院获得性感染的发生率。分析采用治疗权重逆概率（IPTW）进行调整。
总体而言，共纳入225例患者（45例接受达巴万星治疗，180例接受标准治疗）。接受达巴万星治疗的患者社区获得性感染和吸毒者的发生率较高；接受标准治疗的患者合并症更多，菌血症持续时间更长。达巴万星组和标准治疗组的MRSA发生率相似。达巴万星治疗组患者的中位住院时间为16天，而标准治疗组为24天。中心静脉导管置入率在达巴万星组为17.8%，在标准治疗组为57.2%。达巴万星组和标准治疗组分别有13.3%和18.3%的参与者出现90天临床失败。在IPTW调整分析中，序贯使用达巴万星与90天临床失败无关（调整后的优势比为0.94；95%置信区间为0.333 - 2.32）。
本研究提供了初步证据，表明部分接受达巴万星序贯治疗的BSI患者临床失败率相似，与标准治疗相比，导管置入率和住院时间显著缩短。需要进一步进行前瞻性评估。
