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Long-Term Suppressive Therapeutic-Drug-Monitoring-Guided Dalbavancin Therapy for Cardiovascular Prosthetic Infections

Dalbavancin represents a promising treatment for cardiovascular prosthetic infections due to its prolonged half-life, bactericidal activity, large spectrum of activity, and excellent biofilm penetration. However, the use of dalbavancin in this setting is limited, and only a few cases have performed...

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Autores principales: Gallerani, Altea, Gatti, Milo, Bedini, Andrea, Casolari, Stefania, Orlando, Gabriella, Puzzolante, Cinzia, Franceschini, Erica, Menozzi, Marianna, Santoro, Antonella, Barp, Nicole, Volpi, Sara, Soffritti, Alessandra, Pea, Federico, Mussini, Cristina, Meschiari, Marianna
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10669433/
https://www.ncbi.nlm.nih.gov/pubmed/37998841
http://dx.doi.org/10.3390/antibiotics12111639
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author Gallerani, Altea
Gatti, Milo
Bedini, Andrea
Casolari, Stefania
Orlando, Gabriella
Puzzolante, Cinzia
Franceschini, Erica
Menozzi, Marianna
Santoro, Antonella
Barp, Nicole
Volpi, Sara
Soffritti, Alessandra
Pea, Federico
Mussini, Cristina
Meschiari, Marianna
author_facet Gallerani, Altea
Gatti, Milo
Bedini, Andrea
Casolari, Stefania
Orlando, Gabriella
Puzzolante, Cinzia
Franceschini, Erica
Menozzi, Marianna
Santoro, Antonella
Barp, Nicole
Volpi, Sara
Soffritti, Alessandra
Pea, Federico
Mussini, Cristina
Meschiari, Marianna
author_sort Gallerani, Altea
collection PubMed
description Dalbavancin represents a promising treatment for cardiovascular prosthetic infections due to its prolonged half-life, bactericidal activity, large spectrum of activity, and excellent biofilm penetration. However, the use of dalbavancin in this setting is limited, and only a few cases have performed therapeutic drug monitoring (TDM) analysis to optimize dosage in suppressive treatments longer than 4 weeks. Our retrospective case series reports the use of dalbavancin in a small cohort of patients with cardiovascular prosthetic infections (cardiac implantable electronic device infections (CEDIs), prosthetic valve endocarditis (PVE), prosthetic vascular graft infections (PVGIs)) treated with dalbavancin as sequential therapy. From May 2019 to May 2023, 14 patients were included: eight cases of PVE (57.1%), seven cases of PVGI (50%), three cases of CEDI (21.4%), and four cases with overlap of infection sites (28.6%). The main pathogen was Staphylococcus aureus (35.7%). Prosthesis replacement was obtained in four patients (28.6%). The median time between symptom onset and the end of treatment was 15 weeks (IQR 7–53), with a median duration of dalbavancin therapy of 8 weeks (IQR 1 to 45 weeks) and 3.5 doses per patient. Among patients managed with TDM-guided strategy, dalbavancin infusion intervals ranged from 4 to 9 weeks. The median length of follow-up was 65 weeks (IQR 23 to 144 weeks). Clinical success was achieved in 10 cases (76.9%); all clinical failures occurred in patients with the implant retained. Among patients monitored by TDM, clinical success was 87.5% vs. 60% in patients treated without TDM. Because of pharmacokinetic individual variability, dalbavancin TDM-guided administration could improve clinical outcomes by individualizing dosing and selecting dosing intervals. This case series seems to suggest a promising role of long-term suppressive dalbavancin treatment for difficult-to-treat cardiovascular prosthesis infection, also with limited surgical indications.
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spelling pubmed-106694332023-11-19 Long-Term Suppressive Therapeutic-Drug-Monitoring-Guided Dalbavancin Therapy for Cardiovascular Prosthetic Infections Gallerani, Altea Gatti, Milo Bedini, Andrea Casolari, Stefania Orlando, Gabriella Puzzolante, Cinzia Franceschini, Erica Menozzi, Marianna Santoro, Antonella Barp, Nicole Volpi, Sara Soffritti, Alessandra Pea, Federico Mussini, Cristina Meschiari, Marianna Antibiotics (Basel) Article Dalbavancin represents a promising treatment for cardiovascular prosthetic infections due to its prolonged half-life, bactericidal activity, large spectrum of activity, and excellent biofilm penetration. However, the use of dalbavancin in this setting is limited, and only a few cases have performed therapeutic drug monitoring (TDM) analysis to optimize dosage in suppressive treatments longer than 4 weeks. Our retrospective case series reports the use of dalbavancin in a small cohort of patients with cardiovascular prosthetic infections (cardiac implantable electronic device infections (CEDIs), prosthetic valve endocarditis (PVE), prosthetic vascular graft infections (PVGIs)) treated with dalbavancin as sequential therapy. From May 2019 to May 2023, 14 patients were included: eight cases of PVE (57.1%), seven cases of PVGI (50%), three cases of CEDI (21.4%), and four cases with overlap of infection sites (28.6%). The main pathogen was Staphylococcus aureus (35.7%). Prosthesis replacement was obtained in four patients (28.6%). The median time between symptom onset and the end of treatment was 15 weeks (IQR 7–53), with a median duration of dalbavancin therapy of 8 weeks (IQR 1 to 45 weeks) and 3.5 doses per patient. Among patients managed with TDM-guided strategy, dalbavancin infusion intervals ranged from 4 to 9 weeks. The median length of follow-up was 65 weeks (IQR 23 to 144 weeks). Clinical success was achieved in 10 cases (76.9%); all clinical failures occurred in patients with the implant retained. Among patients monitored by TDM, clinical success was 87.5% vs. 60% in patients treated without TDM. Because of pharmacokinetic individual variability, dalbavancin TDM-guided administration could improve clinical outcomes by individualizing dosing and selecting dosing intervals. This case series seems to suggest a promising role of long-term suppressive dalbavancin treatment for difficult-to-treat cardiovascular prosthesis infection, also with limited surgical indications. MDPI 2023-11-19 /pmc/articles/PMC10669433/ /pubmed/37998841 http://dx.doi.org/10.3390/antibiotics12111639 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Gallerani, Altea
Gatti, Milo
Bedini, Andrea
Casolari, Stefania
Orlando, Gabriella
Puzzolante, Cinzia
Franceschini, Erica
Menozzi, Marianna
Santoro, Antonella
Barp, Nicole
Volpi, Sara
Soffritti, Alessandra
Pea, Federico
Mussini, Cristina
Meschiari, Marianna
Long-Term Suppressive Therapeutic-Drug-Monitoring-Guided Dalbavancin Therapy for Cardiovascular Prosthetic Infections
title Long-Term Suppressive Therapeutic-Drug-Monitoring-Guided Dalbavancin Therapy for Cardiovascular Prosthetic Infections
title_full Long-Term Suppressive Therapeutic-Drug-Monitoring-Guided Dalbavancin Therapy for Cardiovascular Prosthetic Infections
title_fullStr Long-Term Suppressive Therapeutic-Drug-Monitoring-Guided Dalbavancin Therapy for Cardiovascular Prosthetic Infections
title_full_unstemmed Long-Term Suppressive Therapeutic-Drug-Monitoring-Guided Dalbavancin Therapy for Cardiovascular Prosthetic Infections
title_short Long-Term Suppressive Therapeutic-Drug-Monitoring-Guided Dalbavancin Therapy for Cardiovascular Prosthetic Infections
title_sort long-term suppressive therapeutic-drug-monitoring-guided dalbavancin therapy for cardiovascular prosthetic infections
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10669433/
https://www.ncbi.nlm.nih.gov/pubmed/37998841
http://dx.doi.org/10.3390/antibiotics12111639
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