Comparative Analysis of Dalbavancin versus Other Antimicrobial Options for Gram-Positive Cocci Infections: Effectiveness, Hospital Stay and Mortality.

Mar De Pablo-Miró,Simona Iftimie,Xavier Duran-Jordà,Juan P Horcajada,Inmaculada López-Montesinos,María Del Mar Arenas-Miras,Albert Anglès,Sergi Pujol-Ruiz,Santiago Grau

doi:10.3390/antibiotics10111296

Abstract

Dalbavancin is a new antibiotic that is effective against Gram-positive microorganisms, including methicillin-resistant Staphylococci, and offers the possibility of administering intravenous therapy once weekly in an ambulatory setting. We conducted a multicenter observational case-control study, comparing all patients who received dalbavancin (cases) with hospitalized patients who were treated instead with daptomycin, linezolid or vancomycin (controls), based on clinical diagnosis, main microorganism involved, and age. The primary outcome was the length of hospital stay after starting the study antimicrobial. Secondary outcomes were 7-day and 30-day efficacy, 30-day mortality, 90-day recurrence, 90-day and 6-month hospitalization, presence of adverse events and healthcare-associated infections; 161 patients (44 cases and 117 controls) were included. Bivariate analysis showed that dalbavancin reduced the total length of hospital stay (p < 0.001), with fewer 90-day recurrences (p = 0.005), 6-month hospitalizations related to the same infection (p = 0.004) and non-related hospitalizations (p = 0.035). Multivariate analyses showed that length of hospital stay was significantly shorter in patients treated with dalbavancin (−12.05 days 95% CI [−17.00, −7.11], p < 0.001), and 30-day efficacy was higher in the dalbavancin group (OR 2.62 95% CI [1.07, 6.37], p = 0.034). Although sample size of the study may be a limitation, we can conclude that Dalbavancin is a useful antimicrobial drug against Gram-positive infections, including multidrug-resistant pathogens, and allows for a remarkable reduction in length of hospital stay with greater 30-day efficacy.

Highlights

Gram-positive infections remain an important cause of infection, exhibiting high burden in terms of morbidity and mortality
Patients treated with dalbavancin presented a higher Charlson Comorbidity Index (CCI) score than those treated with the other antimicrobial therapies, this difference being statistically significant (4.0 [interquartile range (IQR) 2.0–6.0] vs. 3.0 [IQR 1.0–5.0], p = 0.043)
Among patients treated with dalbavancin, the most frequent microorganism was Staphylococcus aureus (50%), which was oxacillin-susceptible in 35 controls and 13 cases, and oxacillin-resistant in 38 controls and 9 cases, with no statistically significant differences between groups (p = 0.316)

Summary

Introduction

Gram-positive infections remain an important cause of infection, exhibiting high burden in terms of morbidity and mortality. Due to the high proportion of Gram-positive infections caused by βlactam-resistant microorganisms, vancomycin, daptomycin and linezolid are among the most frequently used therapeutic options [5] Since these antimicrobial therapies have some limitations (those arising from daily intravenous administration), there remains a demand for optimal antibiotic therapies that guarantee a good clinical and microbiological profile, and good therapy compliance, a good safety profile, quality of life and cost-effectiveness. Dalbavancin has been approved in the USA and Europe to treat moderate-to-severe acute bacterial skin and skin-structure infections (ABSSSI), and has shown accelerated discharge of hospitalized patients, non-inferior efficacy and fewer adverse events [7,8] This drug regimen is unique, and lack of experience prompts the need to conduct more studies, especially in real-life scenarios involving other clinical diagnoses

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