Alderson Liam P, Sanikommu Srivani, Mears Simon C, Barnes C Lowry, Stronach Benjamin M, Stambough Jeffrey B, McDonald Jennifer, Motes Traci, Bailey Brett, Dare Ryan K
University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR, USA.
Division of Infectious Diseases, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Arthroplast Today. 2024 Oct 11;30:101505. doi: 10.1016/j.artd.2024.101505. eCollection 2024 Dec.
Dalbavancin (DAL) off-label use for treating bone and joint infections has increased especially as long-term intravenous access is not needed. Little is known about the effectiveness and safety of its use.
This retrospective, single-center, descriptive study included adults treated with DAL for bone or joint infections over a 4-year period (2019-2023). Patient demographics, infection type and location, pre-DAL antibiotic and surgical treatments, indication for DAL, and clinical outcomes were collected. Risk factor analysis for 1-year infection recurrence was performed.
There were 58 patient encounters of bone and/or joint infections treated with DAL. The majority of patients were treated for osteomyelitis (81.0%) followed by native (8.6%) and peri-prosthetic (10.4%) joint infection. Fifty (86.2%) patients underwent surgical intervention, and 17 (68%) of the 25 patients with infected hardware had full hardware removal. The most common pathogen identified was (41; 70.7%), with methicillin-resistant isolated in 23 (40.0%) cases. Ten (17.2%) patients had recurrence within 1 year. Hardware removal was found to significantly decrease the risk of infection recurrence ( = .026). None of the peri-prosthetic joint infection patients had infection recurrence within 1 year.
Our findings support DAL as an effective treatment for bone and joint infection when combined with surgical debridement and hardware removal. Failure to remove infected hardware significantly increased the risk of infection recurrence within 1 year. Randomized controlled trials are needed to further support DAL as a novel treatment for orthopedic infections.
达巴万星（DAL）在治疗骨与关节感染方面的非标签使用有所增加，特别是因为无需长期静脉通路。其使用的有效性和安全性知之甚少。
这项回顾性、单中心、描述性研究纳入了在4年期间（2019 - 2023年）接受DAL治疗骨或关节感染的成年人。收集了患者的人口统计学资料、感染类型和部位、DAL治疗前的抗生素和手术治疗、DAL的适应证以及临床结局。对1年感染复发进行了危险因素分析。
有58例骨和/或关节感染患者接受了DAL治疗。大多数患者接受骨髓炎治疗（81.0%），其次是原发性（8.6%）和人工关节周围（10.4%）关节感染。50例（86.2%）患者接受了手术干预，25例感染植入物的患者中有17例（68%）进行了植入物完全移除。鉴定出的最常见病原体是[具体病原体未给出]（41例；70.7%），23例（40.0%）病例中分离出耐甲氧西林[具体病原体未给出]。10例（17.2%）患者在1年内复发。发现移除植入物可显著降低感染复发风险（P = 0.026）。人工关节周围感染患者在1年内均无感染复发。
我们的研究结果支持DAL与手术清创和移除植入物联合使用时作为骨与关节感染的有效治疗方法。未能移除感染的植入物显著增加了1年内感染复发的风险。需要进行随机对照试验以进一步支持DAL作为骨科感染的新型治疗方法。
