Journal Club

In this feature, a panel of IDSA members identifies and critiques important new studies in the current literature that have a significant impact on the practice of infectious diseases medicine.

• Prolonged Use of Dalbavancin in Bone and Joint Infections

Click here for the previous edition of Journal Club. For a review of other recent research in the infectious diseases literature, see “In the Literature,” by Stanley Deresinski, MD, FIDSA, in each issue of Clinical Infectious Diseases.

Prolonged Use of Dalbavancin in Bone and Joint Infections

Reviewed by Zeina A. Kanafani, MD, MS, FIDSA

The treatment of bone and joint infections requires prolonged duration of antibiotic treatment, particularly in the setting of prosthetic joint infection. Adherence to a prolonged oral antibiotic regimen is often challenging and is proven to be a predictor of clinical response. Dalbavancin is a long-acting lipoglycopeptide that can be administered once weekly or biweekly for the treatment of skin and soft tissue infections caused by susceptible as well as resistant staphylococci.

In this retrospective study published in Antimicrobial Agents and Chemotherapy, the investigators evaluated the safety and efficacy of dalbavancin in the treatment of bone and joint infections. The analysis included 64 patients. Staphylococcus epidermidis was the most commonly-isolated organism (46.9 percent) followed by Staphylococcus aureus (21.9 percent), predominantly methicillin-resistant. Dalbavancin was given most commonly in order to simplify therapy (53.1 percent), because of adverse effects of previous antibiotics (25 percent), or because of treatment failure with prior therapy (21.9 percent). Most patients received dalbavancin at 1 gr intravenously followed by 500 mg once weekly for a range of three to seven doses.

Infection was related to an orthopedic implant in 45 cases. The implant was retained in 23 cases with a success rate of 65.2 percent and was removed in 21 cases with a success rate of 76.2 percent. The clinical cure rate was 73.7 percent among patients without implants. A total of seven adverse events were recorded, none of which resulted in discontinuation of dalbavancin.

The authors concluded that dalbavancin administered at two or more doses is safe and effective in the treatment of bone and joint infections. Prospective studies are needed to confirm these findings.

(Morata et al. Antimicrob Agents Chemother. 2019;63(5):e02280-18.)