Efficacy and Safety of Dalbavancin Monotherapy as Salvage Treatment for Bone and Joint Infection

Abstract

Bone and joint infection (BJI) treatment is challenging with significant morbidity and mortality. Dalbavancin is a semi-synthetic lipoglycopeptide analogue of the teicoplanin class that exhibits bactericidal activity and a long half-life. The use of dalbavancin may be an option in cases of gram-positive BJI. From November 2017 to April 2019, dalbavancin was used in monotherapy as a salvage option for BJI, as follows: 1500 mg, 1st (D1) and 8th (D8) days, repeated if needed. The follow-up period was of 6 months for osteomyelitis and 1 year for prosthetic joint infections (PJIs). The demographics of the 16 patients showed that 75% were men (n=12), with a mean age of 77.8 years [64-90]. The BJI characteristics: 5 cases of vertebral osteomyelitis; 12 cases of lower limb BJI {8 joint infections, among which were 6 PJIs (4 knees, 2 hips) and 4 cases of foot osteomyelitis)}; 2 cases of shoulder PJI. The debridement, antibiotics, irrigation, and implant retention (DAIR) procedure was performed in 83.4% (5/6) of cases. Monobacterial biopsy was obtained in 75% (n=12) of patients with majority of staphylococcus (15/25) dalbavancin susceptible micro-organismes): 14 Staphylococcus aureus (10/14 methicillin susceptible). Twelve patients received 2 doses of dalbavancin. The mean duration of the 1st antibiotherapy was 18.3 days [0-49]. The clinical success rate was 75% at the end of follow-up with no major side effects of dalbavancin. This report highlights the potential role and efficiency of dalbavancin in treating fragile patients who require long-term antimicrobial therapy with excellent tolerance profiles.