Darlow Christopher A, Parsons Joseph, Lucy Danielle, Li Ang, Ratcliffe Libuse, Todd Stacy, Wong Nicholas
Antimicrobial Therapeutics and Pharmacodynamics, University of Liverpool, Liverpool, UK.
Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
Infection. 2025 Jun 23. doi: 10.1007/s15010-025-02585-x.
Dalbavancin is a long-acting lipoglycopeptide with Gram-positive activity, licensed for the treatment of acute bacterial skin and skin-structure infections (ABSSSIs), although off-licence use is increasingly prevalent. We describe our experience in Liverpool of using dalbavancin for off-licence indications and as a risk-reduction strategy in patients at risk of premature hospital discharge.
Patients receiving dalbavancin in the period 1/9/2020-30/4/2024 in Liverpool were identified. Data was extracted by review of patient notes. Primary outcomes were clinical success (resolution of infection without re-admission or further antibiotics) and 90-day mortality.
Ninety-five individual dalbavancin courses were identified. 24/95 were for licensed indications (i.e., ABSSSI without bacteraemia). Off-licence indications included bone and joint infections (BJIs) (30/95), infective endocarditis (IE) (13/95) and Staphylococcus aureus bacteraemia (SAB) (27/95). The clinical success rate and 90-day mortality for ABSSSI without bacteraemia were 91.67% and 4.17%, respectively. BJI without bacteraemia and SAB outcomes were similar (p > 0.999). However, IE had worse rates of clinical success (61.5%, p = 0.072) and 90-day mortality (30.8%, p = 0.042). 10/18 PWIDs who were prematurely discharged achieved clinical success; 17/18 were alive at 90 days.
The data in this retrospective analysis adds to the growing body of evidence that dalbavancin is safe and effective for the treatment of BJIs and SABs. It also reinforces the uncertainty in the literature over the efficacy of use in IE. Additionally, these data demonstrate that dalbavancin may be used successfully as a risk mitigation strategy for PWIDs who may be prematurely discharged from an inpatient stay.
达巴万星是一种具有革兰氏阳性活性的长效脂糖肽，已获许可用于治疗急性细菌性皮肤和皮肤结构感染（ABSSSI），尽管其超适应证使用越来越普遍。我们描述了在利物浦将达巴万星用于超适应证以及作为降低有提前出院风险患者风险的策略的经验。
确定2020年9月1日至2024年4月30日期间在利物浦接受达巴万星治疗的患者。通过查阅患者病历提取数据。主要结局为临床成功（感染消退且未再次入院或未使用进一步的抗生素）和90天死亡率。
确定了95个达巴万星治疗疗程。24/95用于适应证范围内的疾病（即无菌血症的ABSSSI）。超适应证包括骨和关节感染（BJI）（30/95）、感染性心内膜炎（IE）（13/95）和金黄色葡萄球菌菌血症（SAB）（27/95）。无菌血症的ABSSSI的临床成功率和90天死亡率分别为91.67%和4.17%。无菌血症的BJI和SAB的结局相似（p>0.999）。然而，IE的临床成功率较低（61.5%，p=0.072），90天死亡率较高（30.8%，p= 0.042）。10/18例提前出院的注射吸毒者取得了临床成功；17/18例在90天时存活。
这项回顾性分析中的数据进一步证明，达巴万星治疗BJI和SAB安全有效。这也强化了文献中关于其在IE治疗中疗效的不确定性。此外，这些数据表明，达巴万星可成功用作可能提前出院的注射吸毒者的风险缓解策略。
