Polega James, Bhugra Mudita, Vanderhorst Derek, de Sanctis Jorgelina, Chang Aaron, Hassouna Habiba
Infectious Disease, Corewell Health/Michigan State University, Grand Rapids, USA.
Pharmacy, Corewell Health/Michigan State University, Grand Rapids, USA.
Cureus. 2025 Mar 31;17(3):e81505. doi: 10.7759/cureus.81505. eCollection 2025 Mar.
Introduction Outpatient management of serious bacterial infections can be difficult particularly in situations where outpatient parenteral antibiotic therapy may be difficult due to patient-specific factors such as history of medical non-compliance, unstable housing situations, and individuals who use injection drugs. Dalbavancin is a long-acting lipoglycopeptide antibiotic currently approved for the treatment of bacterial skin and soft tissue infections; however, it is often employed in the management of other infections caused by gram-positive organisms. Data regarding the off-label usage of dalbavancin remains an emerging area of study. Methods A retrospective cohort study of all 52 inpatients, ages 18-56, who received ≥1 dose of dalbavancin between November 2017 and February 2023 was conducted. Rates of treatment completion and clinical cure were assessed at 42 days post-dalbavancin treatment. Results Fifty-two adults were identified. Dalbavancin was used to treat skin/soft tissue infections in 12 patients (23.5%). Off-label uses accommodated for 40 patients, with diagnoses including as follows: bloodstream infection (21, 41.2%), osteomyelitis (12, 23.5%), septic arthritis (10, 13.3%), native valve infective endocarditis (six, 11.8%), prosthetic joint infection (three, 5.9%), epidural abscess (three, 5.9%), catheter-related bloodstream infection (one, 2%), and other infections (13, 25.5%). Among patients who completed therapy, cure, as assessed at day 42, was achieved in 35 (67.6%) patients. Intravenous (IV) drug and the need for facility placement to receive IV antibiotics use were the commonly cited reasons for dalbavancin utilization. Adverse events included mild elevation in serum aminotransferases which occurred in six patients (11.5%) and acute kidney injury which occurred in two (3.8%). There were no adverse events resulting in drug discontinuation. Conclusions Dalbavancin use, including off-label indications, such as bacteremia, septic arthritis, osteomyelitis, prosthetic joint infection, and others, appears safe and associated with favorable treatment responses. Therefore, it can be considered as an alternative treatment approach in patients who may not be candidates for traditional outpatient parenteral antimicrobial therapy.
引言 严重细菌感染的门诊管理可能具有挑战性，特别是在由于患者特定因素（如医疗不依从史、不稳定的居住情况以及注射吸毒者）导致门诊胃肠外抗生素治疗可能困难的情况下。达巴万星是一种长效脂糖肽类抗生素，目前已被批准用于治疗细菌性皮肤和软组织感染；然而，它也常用于治疗由革兰氏阳性菌引起的其他感染。关于达巴万星非标签用法的数据仍是一个新兴的研究领域。方法 对2017年11月至2023年2月期间接受≥1剂达巴万星治疗的所有52例年龄在18 - 56岁的住院患者进行回顾性队列研究。在达巴万星治疗后42天评估治疗完成率和临床治愈率。结果 共确定了52名成年人。达巴万星用于治疗12例患者（23.5%）的皮肤/软组织感染。非标签用法适用于40例患者，诊断包括：血流感染（21例，41.2%）、骨髓炎（12例，23.5%）、化脓性关节炎（10例，13.3%）、天然瓣膜感染性心内膜炎（6例，11.8%）、人工关节感染（3例，5.9%）、硬膜外脓肿（3例，5.9%）、导管相关血流感染（1例，2%）以及其他感染（13例，25.5%）。在完成治疗的患者中，42天时评估有35例（67.6%）患者达到治愈。静脉注射（IV）吸毒以及需要住院接受静脉抗生素治疗是使用达巴万星的常见原因。不良事件包括6例患者（11.5%）出现血清氨基转移酶轻度升高，2例患者（3.8%）出现急性肾损伤。没有不良事件导致停药。结论 使用达巴万星，包括用于菌血症、化脓性关节炎、骨髓炎、人工关节感染等非标签适应症，似乎是安全的，且与良好的治疗反应相关。因此，对于可能不适合传统门诊胃肠外抗菌治疗的患者，可将其视为一种替代治疗方法。
