Aparicio-Minguijón Eduardo, Boán Jorge, Terrón Antonio, Heredia Carlos, Puente Cristina, Pérez-Jacoiste Asín Asunción, Orellana M Ángeles, Domínguez Laura, Caro José Manuel, López-Gude M Jesús, Aguilar-Blanco Eva María, Eixerés-Esteve Andrea, López-Medrano Francisco
Department of Internal Medicine, University Hospital '12 de Octubre', Spain.
Department of Internal Medicine, University Hospital '12 de Octubre', Spain.
Enferm Infecc Microbiol Clin (Engl Ed). 2025 Feb;43(2):86-92. doi: 10.1016/j.eimce.2024.04.012. Epub 2024 Jun 19.
This study aimed to evaluate the effectiveness of dalbavancin as sequential therapy in patients with infective endocarditis (IE) due to gram positive bacteria (GPB) in a real-life heterogenous cohort with comorbid patients.
A single center retrospective cohort study including all patients with definite IE treated with dalbavancin between January 2017 and February 2022 was developed. A 6-month follow-up was performed. The main outcomes were clinical cure rate, clinical and microbiological relapse, 6-month mortality, and adverse effects (AEs) rate.
The study included 61 IE episodes. The median age was 78.5 years (interquartile range [IQR] 63.2-85.2), 78.7% were male, with a median Charlson comorbidity index of 7 (IQR 4-9) points. Overall, 49.2% suffered native valve IE. The most common microorganism was Staphylococcus aureus (26.3%) followed by Enterococcus faecalis (21.3%). The median duration of initial antimicrobial therapy and dalbavancin therapy were 27 (IQR 20-34) and 14 days (IQR 14-28) respectively. The total reduction of hospitalization was 1090 days. The most frequent dosage was 1500mg of dalbavancin every 14 days (96.7%). An AE was detected in 8.2% of patients, only one (1.6%) was attributed to dalbavancin (infusion reaction). Clinical cure was achieved in 86.9% of patients. One patient (1.6%) with Enterococcus faecalis IE suffered relapse. The 6-month mortality was 11.5%, with only one IE-related death (1.6%).
This study shows a high efficacy of dalbavancin in a heterogeneous real-world cohort of IE patients, with an excellent safety profile. Dalbavancin allowed a substantial reduction of in-hospital length of stay.
本研究旨在评估在合并症患者组成的真实异质性队列中，达巴万星作为序贯疗法治疗革兰氏阳性菌（GPB）所致感染性心内膜炎（IE）患者的有效性。
开展一项单中心回顾性队列研究，纳入2017年1月至2022年2月期间所有接受达巴万星治疗的确诊IE患者。进行为期6个月的随访。主要结局指标为临床治愈率、临床和微生物学复发率、6个月死亡率以及不良反应（AE）发生率。
该研究纳入61例IE发作病例。中位年龄为78.5岁（四分位间距[IQR]63.2 - 85.2），78.7%为男性，Charlson合并症指数中位数为7分（IQR 4 - 9）。总体而言，49.2%的患者患有自体瓣膜IE。最常见的微生物是金黄色葡萄球菌（26.3%），其次是粪肠球菌（21.3%）。初始抗菌治疗和达巴万星治疗的中位持续时间分别为27天（IQR 20 - 34）和14天（IQR 14 - 28）。住院总天数减少了1090天。最常用的剂量是每14天使用1500mg达巴万星（96.7%）。8.2%的患者检测到AE，仅1例（1.6%）归因于达巴万星（输液反应）。86.9%的患者实现临床治愈。1例粪肠球菌IE患者（1.6%）出现复发。6个月死亡率为11.5%，仅1例IE相关死亡（1.6%）。
本研究表明，在异质性的真实世界IE患者队列中，达巴万星具有高效性且安全性良好。达巴万星可大幅缩短住院时间。
