Dalbavancin Sequential Therapy for Gram-Positive Bloodstream Infection: A Multicenter Observational Study

Nicholas Rebold^{1

2

3}, Sara Alosaimy^{4

5}, Jeffrey C Pearson⁶, Brandon Dionne^{6

7}, Ahmad Taqi⁶, Abdalhamid Lagnf^{4

5

8}, Kristen Lucas^{4

5}, Mark Biagi^{9

10}, Nicholas Lombardo¹⁰, Joshua Eudy¹¹, Daniel T Anderson¹¹, Monica V Mahoney¹², Wesley D Kufel^{13

14}, Joseph A D'Antonio¹⁴, Bruce M Jones¹⁵, Jeremy J Frens¹⁶, Tyler Baumeister¹⁶, Matthew Geriak¹⁷, George Sakoulas^{18

19}, Dimitrios Farmakiotis^{20

21}, Dino Delaportas²², Jeremy Larew²², Michael P Veve^{4

23

24}, Michael J Rybak^{25

26

27

28}

Affiliations

¹ Wayne State University, Detroit, MI, USA. nicholas.rebold@howard.edu.
² Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA. nicholas.rebold@howard.edu.
³ Department of Clinical and Administrative Pharmacy Sciences, College of Pharmacy, Howard University, 2300 4th St NW, Office 114, Washington, DC, 20059, USA. nicholas.rebold@howard.edu.
⁴ Wayne State University, Detroit, MI, USA.
⁵ Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA.
⁶ Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, USA.
⁷ School of Pharmacy, Northeastern University, Boston, MA, USA.
⁸ Detroit Medical Center, Detroit Receiving Hospital, Detroit, MI, USA.
⁹ College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA.
¹⁰ Department of Pharmacy, Swedish American Health System, Rockford, IL, USA.
¹¹ Department of Pharmacy, Augusta University Medical Center, Augusta, GA, USA.
¹² Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, MA, USA.
¹³ Department of Medicine, State University of New York Upstate Medical University, Syracuse, NY, USA.
¹⁴ Department of Pharmacy Practice, Binghamton University School of Pharmacy and Pharmaceutical Sciences, Binghamton, NY, USA.
¹⁵ Department of Pharmacy, St. Joseph's/Candler Health System, Savannah, GA, USA.
¹⁶ Department of Pharmacy, Moses H. Cone Memorial Hospital, Cone Health, Greensboro, NC, USA.
¹⁷ Sharp Memorial Hospital, Sharp Healthcare, San Diego, CA, USA.
¹⁸ Sharp Rees-Stealy Medical Group, San Diego, CA, USA.
¹⁹ University of California San Diego School of Medicine, Division of Host-Microbe Systems and Therapeutics, La Jolla, CA, USA.
²⁰ Division of Infectious Diseases, Warren Alpert Medical School of Brown University, Providence, RI, USA.
²¹ Transplant and Oncology Infectious Diseases, Rhode Island Hospital, Providence, RI, USA.
²² Mon Health Medical Center, Morgantown, WV, USA.
²³ College of Pharmacy, University of Tennessee, Knoxville, TN, USA.
²⁴ Department of Pharmacy, Henry Ford Health System, Detroit, MI, USA.
²⁵ Wayne State University, Detroit, MI, USA. m.rybak@wayne.edu.
²⁶ Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA. m.rybak@wayne.edu.
²⁷ Detroit Medical Center, Detroit Receiving Hospital, Detroit, MI, USA. m.rybak@wayne.edu.
²⁸ School of Medicine, Wayne State University, Detroit, MI, USA. m.rybak@wayne.edu.

PMID: 38427289
PMCID: PMC10965835
DOI: 10.1007/s40121-024-00933-2

Dalbavancin Sequential Therapy for Gram-Positive Bloodstream Infection: A Multicenter Observational Study

Nicholas Rebold et al. Infect Dis Ther. 2024 Mar.

. 2024 Mar;13(3):565-579.

doi: 10.1007/s40121-024-00933-2. Epub 2024 Mar 1.

Authors

Affiliations

¹ Wayne State University, Detroit, MI, USA. nicholas.rebold@howard.edu.
² Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA. nicholas.rebold@howard.edu.
³ Department of Clinical and Administrative Pharmacy Sciences, College of Pharmacy, Howard University, 2300 4th St NW, Office 114, Washington, DC, 20059, USA. nicholas.rebold@howard.edu.
⁴ Wayne State University, Detroit, MI, USA.
⁵ Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA.
⁶ Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, USA.
⁷ School of Pharmacy, Northeastern University, Boston, MA, USA.
⁸ Detroit Medical Center, Detroit Receiving Hospital, Detroit, MI, USA.
⁹ College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA.
¹⁰ Department of Pharmacy, Swedish American Health System, Rockford, IL, USA.
¹¹ Department of Pharmacy, Augusta University Medical Center, Augusta, GA, USA.
¹² Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, MA, USA.
¹³ Department of Medicine, State University of New York Upstate Medical University, Syracuse, NY, USA.
¹⁴ Department of Pharmacy Practice, Binghamton University School of Pharmacy and Pharmaceutical Sciences, Binghamton, NY, USA.
¹⁵ Department of Pharmacy, St. Joseph's/Candler Health System, Savannah, GA, USA.
¹⁶ Department of Pharmacy, Moses H. Cone Memorial Hospital, Cone Health, Greensboro, NC, USA.
¹⁷ Sharp Memorial Hospital, Sharp Healthcare, San Diego, CA, USA.
¹⁸ Sharp Rees-Stealy Medical Group, San Diego, CA, USA.
¹⁹ University of California San Diego School of Medicine, Division of Host-Microbe Systems and Therapeutics, La Jolla, CA, USA.
²⁰ Division of Infectious Diseases, Warren Alpert Medical School of Brown University, Providence, RI, USA.
²¹ Transplant and Oncology Infectious Diseases, Rhode Island Hospital, Providence, RI, USA.
²² Mon Health Medical Center, Morgantown, WV, USA.
²³ College of Pharmacy, University of Tennessee, Knoxville, TN, USA.
²⁴ Department of Pharmacy, Henry Ford Health System, Detroit, MI, USA.
²⁵ Wayne State University, Detroit, MI, USA. m.rybak@wayne.edu.
²⁶ Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA. m.rybak@wayne.edu.
²⁷ Detroit Medical Center, Detroit Receiving Hospital, Detroit, MI, USA. m.rybak@wayne.edu.
²⁸ School of Medicine, Wayne State University, Detroit, MI, USA. m.rybak@wayne.edu.

PMID: 38427289
PMCID: PMC10965835
DOI: 10.1007/s40121-024-00933-2

Abstract

Introduction: Long-acting lipoglycopeptides such as dalbavancin may have utility in patients with Gram-positive bloodstream infections (BSI), particularly in those with barriers to discharge or who require prolonged parenteral antibiotic courses. A retrospective cohort study was performed to provide further multicenter real-world evidence on dalbavancin use as a sequential therapy for Gram-positive BSI.

Methods: One hundred fifteen patients received dalbavancin with Gram-positive BSI, defined as any positive blood culture or diagnosed with infective endocarditis, from 13 centers geographically spread across the United States between July 2015 and July 2021.

Results: Patients had a mean (SD) age of 48.5 (17.5) years, the majority were male (54%), with many who injected drugs (40%). The most common infection sources (non-exclusive) were primary BSI (89%), skin and soft tissue infection (SSTI) (25%), infective endocarditis (19%), and bone and joint infection (17%). Staphylococcus aureus accounted for 72% of index cultures, coagulase-negative Staphylococcus accounted for 18%, and Streptococcus species in 16%. Dalbavancin started a median (Q₁-Q₃) of 10 (6-19) days after index culture collection. The most common regimen administered was dalbavancin 1500 mg as one dose for 50% of cases. The primary outcome of composite clinical failure occurred at 12.2%, with 90-day mortality at 7.0% and 90-day BSI recurrence at 3.5%.

Conclusions: Dalbavancin may serve as a useful tool in facilitating hospital discharge in patients with Gram-positive BSI. Randomized controlled trials are anticipated to validate dalbavancin as a surrogate to current treatment standards.

Keywords: Staphylococcus; Streptococcus; Bacteremia; Bloodstream infection; Dalbavancin; Glycopeptides; Injection drug use.

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Conflict of interest statement

Nicholas Rebold, Jeffery C. Pearson, Brandon Dionne, Ahmad Taqi, Abdalhamid Lagnf, Kristen Lucas, Mark Biagi, Nicholas Lombardo, Joshua Eudy, Daniel T. Anderson, Joseph A. D’Antonio, Jeremy J Frens, Tyler Baumeister, Matthew Geriak, Dino Delaportas, Jeremy Larew, and Michael P. Veve have no conflicts of interest to report. Sara Alosaimy is a current employee of Seres Therapeutics. Monica V. Mahoney has received funds for research from Merck; consulting funds from Cidara, Melinta, Merck, Pfizer, Qpex, and Spero; speaker honoraria from Paratek. Wesley D. Kufel has received research grants from Merck and Melinta; served on the advisory board for Theratechnologies, Inc.; Bruce M. Jones has received funds for consulting or participated in speaking bureaus for AbbVie, Melinta, Merck, Paratek, and La Jolla. George Sakoulas has consulted for Octapharma, AbbVie, and Paratek Pharmaceuticals and is on the speakers bureau for AbbVie and Paratek Pharmaceuticals. Dimitrios Farmakiotis has received research support from Astellas, Viracor and Merck, and consultation fee from Viracor. Michael J. Rybak has received funds for research and consulting or participated in speaking bureaus for AbbVie, Ferring, Melinta, Merck, Paratek Pharmaceuticals, Shionogi, Spero, La Jolla, and T2 Bioscience and was/is partially supported by National Institute of Allergy and Infectious Diseases R01 AI121400 and R21 AI163726. Michael J. Rybak is Editor in Chief of Infectious Diseases and Therapy. Michael J. Rybak was not involved in the selection of peer reviewers for the manuscript nor any of the subsequent editorial decisions. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

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Dalbavancin Sequential Therapy for Gram-Positive Bloodstream Infection: A Multicenter Observational Study

Affiliations

Dalbavancin Sequential Therapy for Gram-Positive Bloodstream Infection: A Multicenter Observational Study

Authors

Affiliations

Abstract

Conflict of interest statement

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References

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