Leung Wayne, Bhalla Janhavi, Ataie Lili, Elsayed Sameer, Bondy Lise, Devlin Megan, Shalhoub Sarah, Saeed Huma, Mohammadi Mahshid, Silverman Michael, Shahmirzadi Reza Rahimi
London Health Sciences Centre, Infectious Diseases, London, Ontario, Canada.
Western University, Schulich School of Medicine, London, Ontario, Canada.
J Assoc Med Microbiol Infect Dis Can. 2025 Jan 30;10(1):40-52. doi: 10.3138/jammi-2024-0015. eCollection 2025 Mar.
Treatment of acute bacterial skin and skin structure infections (ABSSSIs) with intravenous (IV) antibiotics is difficult in marginalized populations, such as people who inject drugs, due to issues such as unstable housing or mental health conditions. These factors often require extended hospital admissions for IV antibiotics. Dalbavancin, a novel lipoglycopeptide antibiotic effective against gram-positive bacteria, lasts over 14 days and may be suitable for patients who struggle with traditional IV antibiotic administration.
This was a case series in which we reviewed 19 patients referred to our cellulitis clinic in London, Ontario, Canada, between February 1 and July 30, 2023, who received a single dose of IV dalbavancin for ABSSSIs as out-patients. Those who were enrolled had severe infections requiring IV antibiotics, with psychosocial factors pre-cluding out-patient IV therapy, or were at high risk of non-adherence to oral antibiotics.
The median age of patients was 43 (range 36-56 years); they were mostly male (74%), unemployed (89%), and with unstable housing (58%). Positive outcomes were observed in 13 out of 19 (68%) patients; 3 out of 19 had indeterminate outcomes (could not be reached for follow-up but were not admitted to any institution within our catchment area) and 3 out of 19 had negative outcomes (needed further antibiotics following dalbavancin).
Our experience shows that a single IV dose of dalbavancin is effective in treating ABSSSIs in patients with complex psychosocial factors, as positive outcomes were observed in most patients. Dalbavancin eliminates the need for indwelling IV access and may reduce hospital admissions for patients for whom traditional antibiotic regimens may be challenging.
对于边缘化人群，如注射吸毒者，由于住房不稳定或心理健康状况等问题，使用静脉注射（IV）抗生素治疗急性细菌性皮肤和皮肤结构感染（ABSSSI）存在困难。这些因素通常需要延长住院时间以使用静脉注射抗生素。达巴万星是一种新型的对革兰氏阳性菌有效的脂糖肽类抗生素，其药效可持续超过14天，可能适用于难以接受传统静脉注射抗生素治疗的患者。
这是一个病例系列，我们回顾了2023年2月1日至7月30日期间转诊至加拿大安大略省伦敦市我们的蜂窝织炎诊所的19例患者，这些患者作为门诊患者接受了单剂量静脉注射达巴万星治疗ABSSSI。纳入的患者患有严重感染，需要静脉注射抗生素，且社会心理因素排除了门诊静脉治疗，或者有不坚持口服抗生素治疗的高风险。
患者的中位年龄为43岁（范围36 - 56岁）；他们大多为男性（74%），失业（89%），且住房不稳定（58%）。19例患者中有13例（68%）观察到阳性结果；19例中有3例结果不确定（无法进行随访，但未在我们的服务区域内的任何机构住院），19例中有3例结果为阴性（达巴万星治疗后需要进一步使用抗生素）。
我们的经验表明，单剂量静脉注射达巴万星对患有复杂社会心理因素的患者治疗ABSSSI有效，因为大多数患者观察到了阳性结果。达巴万星无需留置静脉通路，对于传统抗生素治疗方案可能具有挑战性的患者，可能会减少住院次数。
