Mazzitelli Maria, Gatti Milo, Scaglione Vincenzo, Mengato Daniele, Trevenzoli Marco, Sattin Andrea, Pea Federico, Cattelan Anna Maria
Infectious and Tropical Diseases Unit, Padua University Hospital, Via Giustiniani, 35128 Padua, Italy.
Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy.
Antibiotics (Basel). 2022 Oct 8;11(10):1377. doi: 10.3390/antibiotics11101377.
Background: Our aim was to describe the clinical outcome and safety of the sequential treatment with off-label dalbavancin in patients with spondylodiscitis that is caused by methicillin-resistant Staphylococcus aureus (MRSA). Methods: We retrospectively included all patients >18 years of age with spondylodiscitis that is caused by MRSA that was treated with dalbavancin from January 2018−January 2021, recording the instances of clinical cure/failure, adverse events, and the need to be re-hospitalized after the initiation of dalbavancin. In 2/15 patients, we performed therapeutic drug monitoring (TDM) for dalbavancin. Results: We included 15 patients, 53.3% of them were females, with a median age of 67.9 years (57.4−78.5); 100% patients reported back pain, while a fever was present only in 2/15 cases. The spondylodiscitis was localized in 86.6% cases at the lumbar level. A median of a 2-week in-hospital intravenous vancomycin was followed by dalbavancin with a median duration of 12 weeks (12−16). All patients reported a clinical cure, except for a woman who is still on a suppressive treatment. No patient needed to be re-hospitalized, access to emergency department, or experienced adverse events. The TDM for dalbavancin showed that more than 90% of the determinations were above the pharmacodynamic target against staphylococci. Conclusions: The results from our unique, even if it was small, cohort demonstrated that dalbavancin can be a safe/effective option as a sequential treatment in patients with serious infections requiring prolonged antibiotic therapy, such as spondylodiscitis.
我们的目的是描述在耐甲氧西林金黄色葡萄球菌（MRSA）引起的脊椎骨髓炎患者中，使用超说明书剂量达巴万星序贯治疗的临床疗效和安全性。方法：我们回顾性纳入了2018年1月至2021年1月期间所有年龄大于18岁、由MRSA引起的脊椎骨髓炎且接受达巴万星治疗的患者，记录临床治愈/失败情况、不良事件以及开始使用达巴万星后再次住院的需求。在15例患者中的2例中，我们对达巴万星进行了治疗药物监测（TDM）。结果：我们纳入了15例患者，其中53.3%为女性，中位年龄为67.9岁（57.4 - 78.5）；100%的患者报告有背痛，而仅2/15的病例有发热。86.6%的病例脊椎骨髓炎局限于腰椎水平。中位住院2周静脉注射万古霉素后使用达巴万星，中位疗程为12周（12 - 16周）。除一名仍在接受抑制性治疗的女性外，所有患者均报告临床治愈。没有患者需要再次住院、前往急诊科或发生不良事件。达巴万星的TDM显示，超过90%的测定值高于针对葡萄球菌的药效学目标。结论：我们独特的、尽管规模较小的队列研究结果表明，对于需要长期抗生素治疗的严重感染患者，如脊椎骨髓炎患者，达巴万星作为序贯治疗可能是一种安全/有效的选择。
