Bresges Carolin, Bresges Kristina, Hewitt Claudette, Sharma Sunil, Davies Bethany
Brighton and Sussex Medical School Department of Global Health and Infection, University of Sussex, 94 N-S Road, Falmer, Brighton BN1 9PX, UK.
The Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Eastern Road, Brighton BN2 5BE, UK.
JAC Antimicrob Resist. 2024 May 6;6(3):dlae066. doi: 10.1093/jacamr/dlae066. eCollection 2024 Jun.
Dalbavancin's unique properties have led to an increase in its off-licence use in complex infection and in vulnerable populations including people who inject drugs (PWID), but data remain limited. In this retrospective cohort study, we describe the characteristics, treatment rationale and outcomes for all adult inpatients treated with dalbavancin at a UK tertiary hospital.
Fifty-eight inpatients were treated with dalbavancin between 1 January 2018 and 1 January 2021, 98.3% for off-licence diagnoses. Acute bacterial skin and skin structure infection, infective endocarditis and endovascular infections were each diagnosed in 22.4% of patients. Bone and joint infections were diagnosed in 18.9%, discitis in 12.1% and central line-associated bloodstream infections in 5.2%. Sixty-nine percent of patients were bacteraemic; 52.5% , 5.0% MRSA. Two mild adverse reactions were attributed to dalbavancin. Treatment was successful in 43 (75.4%) patients, and failed in seven (12.3%). Seven (12.3%) were lost to follow-up.Thirty-five patients (60.3%) were PWID, with low median age (41.0 years) and Charlson Comorbidity scores (0). Self-discharge was taken by 17.1% of PWID, and 20.6% were lost to follow-up. At 90 days, three (8.6%) PWID were deceased.
In this first UK cohort, dalbavancin was used off licence and in persons facing barriers to conventional therapies. Where data is available, it was safe and effective. Dalbavancin appears a potentially valuable tool in improving outcomes for PWID.
达巴万星的独特特性导致其在复杂感染以及包括注射吸毒者（PWID）在内的弱势群体中未按药品许可使用的情况有所增加，但相关数据仍然有限。在这项回顾性队列研究中，我们描述了英国一家三级医院接受达巴万星治疗的所有成年住院患者的特征、治疗原理和治疗结果。
在2018年1月1日至2021年1月1日期间，58名住院患者接受了达巴万星治疗，其中98.3%为未按药品许可的诊断。急性细菌性皮肤和皮肤结构感染、感染性心内膜炎和血管内感染在各22.4%的患者中被诊断出。骨和关节感染在18.9%的患者中被诊断出，椎间盘炎在12.1%的患者中被诊断出，中心静脉导管相关血流感染在5.2%的患者中被诊断出。69%的患者发生菌血症；52.5%为甲氧西林耐药金黄色葡萄球菌（MRSA），5.0%为甲氧西林敏感金黄色葡萄球菌。有两例轻度不良反应归因于达巴万星。43例（75.4%）患者治疗成功，7例（12.3%）治疗失败。7例（12.3%）失访。35例患者（60.3%）为注射吸毒者，年龄中位数较低（41.0岁），查尔森合并症评分（0）。17.1%的注射吸毒者自行出院，20.6%失访。在90天时，3例（8.6%）注射吸毒者死亡。
在这个英国首个队列中，达巴万星用于未按药品许可的情况以及面临传统治疗障碍的人群。在有数据的情况下，它是安全有效的。达巴万星似乎是改善注射吸毒者治疗结果的一个潜在有价值的工具。
