Doub James B, Alkayali Talal, Amoroso Anthony, Nandi Sumon, Talwani Rohit
The Doub Laboratory of Translational Bacterial Research, University of Maryland School of Medicine, 725 west Lombard Street, Baltimore, MD, 21201, USA.
Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.
Eur J Orthop Surg Traumatol. 2023 Dec;33(8):3655-3659. doi: 10.1007/s00590-023-03609-8. Epub 2023 Jun 4.
Dalbavancin is an attractive antibiotic for the treatment of Gram-positive musculoskeletal infections given its long half-life and prolonged duration in cortical bones. For certain patient populations compliance with antibiotic regimens can be problematic. Therefore, the purpose of this study was to assess the effectiveness, tolerance, and compliance of treating prosthetic joint and spinal hardware infections with a unique two-dose regimen of dalbavancin.
Identification of patients that had prosthetic joint infections and spinal hardware infections from January 1, 2017, through December 31, 2021, that had received a two-dose regimen of dalbavancin for these infections was conducted. Patient demographics, infection recurrence, compliance and adverse drug reactions to the two-dose regimen of dalbavancin were recorded. Furthermore, preserved clinical isolates from these infections were assessed for susceptibility to dalbavancin with microbroth dilutions.
All patients were fully compliant with the two dose dalbavancin regimen and no patient had any adverse reactions to the two-dose dalbavancin regimen. Thirteen of fifteen patients (85.7%) have not had any recurrence of their infections and all preserved clinical isolates showed susceptibility to dalbavancin.
The two-dose regimen of dalbavancin is an effective and attractive option in treating prosthetic joint and spinal hardware infections to forgo long term central venous access and ensure compliance. However, the use of rifampin and suppression antibiotics still needs to be considered when treating these infections. Nonetheless this study supports that a two-dose dalbavancin regimen is a viable alternative in certain clinical settings and consideration for a randomized controlled clinical trial should be entertained to prove its non-inferiority to conventional treatments.
达巴万星因其半衰期长且在皮质骨中停留时间长，是治疗革兰氏阳性肌肉骨骼感染的一种有吸引力的抗生素。对于某些患者群体，抗生素治疗方案的依从性可能存在问题。因此，本研究的目的是评估一种独特的两剂量达巴万星方案治疗人工关节和脊柱内固定感染的有效性、耐受性和依从性。
识别2017年1月1日至2021年12月31日期间接受过两剂量达巴万星治疗人工关节感染和脊柱内固定感染的患者。记录患者的人口统计学信息、感染复发情况、对达巴万星两剂量方案的依从性和药物不良反应。此外，对这些感染中保存的临床分离株进行微量肉汤稀释法评估其对达巴万星的敏感性。
所有患者均完全依从达巴万星两剂量方案，且无患者对达巴万星两剂量方案有任何不良反应。15名患者中有13名（85.7%）未出现感染复发，所有保存的临床分离株均对达巴万星敏感。
达巴万星两剂量方案是治疗人工关节和脊柱内固定感染的一种有效且有吸引力的选择，可避免长期中心静脉置管并确保依从性。然而，在治疗这些感染时仍需考虑使用利福平和抑制性抗生素。尽管如此，本研究支持在某些临床环境中，两剂量达巴万星方案是一种可行的替代方案，应考虑进行随机对照临床试验以证明其不劣于传统治疗方法。
