Dalbavancina como tratamiento antibiótico de consolidación en endocarditis infecciosa, infección de dispositivos de estimulación cardiaca y bacteriemia: experiencia clínica de 7 años

Abstract

IntroductionDalbavancin (DBV), a novel lipoglycopeptide with activity against Gram-positive bacterial infections, is approved for the treatment of acute bacterial skin and skin structure infections. It has linear dose-related pharmacokinetics allowing a prolonged interval between doses. It would be a good option for the treatment of patients with Gram-positive cardiovascular infections. Material and methodsRetrospective analysis of patients with cardiovascular infection (bacteremia, implantable electronic device infection and infective endocarditis [IE]) treated with DBV at Hospital Clínico San Carlos (Madrid) for 7 years (2016-2022). Patients were divided into 2 study groups: 1) IE, and 2) bacteremia. Epidemiological, clinical, microbiological and therapeutic data were analyzed. ResultsA total of 25 patients were treated with DBV for cardiovascular infection. IE was the most common indication (68%), followed by bacteremia (32%) with male predominance in both groups (64 vs. 62%) and median age of 67,7 and 57,5 years, respectively. Hundred percent of blood cultures were positive to Gram-positive microorganisms (Staphylococcus spp., Streptococcus spp. or Enterococcus spp.) in both study groups. Previously to DBV, all patients received other antibiotic therapy, both in the group of IE (median: 80 days) as in bacteremia (14,8 days). The main reason for the administration of DBV was to continue intravenous antimicrobial therapy outside the hospital in both the EI group (n=15) and the bacteremia group (n=8). DBV was used as consolidation therapy in a once- or twice-weekly regimen. Microbiological and clinical successes were reached in 84% of cases (n=21), 76,4% in IE group and 100% in bacteremia group. No patient documented adverse effects during long-term DBV treatment. ConclusionDBV is an effective and safety treatment as consolidation antibiotic therapy in IE and bacteremia produced by Gram-positive microorganisms.