scholarly journals 614. Evaluating the Use of Dalbavancin for Off-Label Indications

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S410-S410
Author(s):  
Katherine Taylor ◽  
John Williamson ◽  
Tyler Stone ◽  
James Johnson ◽  
Zachary Gruss ◽  
...  
Keyword(s):  
Drug Users ◽  
Financial Analysis ◽  
Clinical Success ◽  
Joint Infection ◽  
Alternative Therapy ◽  
Skilled Nursing Facility ◽  
Cost Avoidance ◽  
Off Label ◽  
Prosthetic Joint ◽  
Post Marketing

Abstract Background Dalbavancin (dalba) is a long-acting antibiotic (ABX) approved for skin and soft tissue infections. Post-marketing data suggests dalba is being used for off-label indications that require long term IV ABX; however, data assessing this off-label usage is limited. The purpose of this study was to evaluate the real-world efficacy, safety, and financial impact of off-label dalba use. Methods Setting: 4-hospital health system. Design: retrospective, observational study. Adult patients (pts) who received dalba from Jan 2018 to Jan 2021 for an off-label indication were included. Pts who were pregnant or had an infection caused by a pathogen outside dalba’s antimicrobial spectrum were excluded. Primary outcome was clinical success at 90 days defined as no need for additional ABX (excluding suppression therapy) or surgical intervention following dalba therapy and no positive cultures post treatment associated with the dalba-targeted infection. Secondary outcomes included safety (nephrotoxicity and hepatotoxicity). A financial analysis was performed by subtracting the cost of dalba from the anticipated cost of pt stay [&427/day for hospital; &262/day for skilled nursing facility (SNF)] if standard IV therapy was given. Results 50 pts met study criteria; 42% were IV drug users; 14% were self-pay. Indications included osteomyelitis (54%), endocarditis (22%), bacteremia (16%), and prosthetic joint infection (PJI) (8%). The predominant organism was S. aureus (60%), with 42% caused by MRSA. All but 1 pt received 1.5 g of dalba. 20 (40%) pts received 1 dose; 26 (52%) received 2. Overall, 43 (86%) pts achieved clinical success at 90 days, including 87% of osteomyelitis/PJI pts, 82% of endocarditis pts, and 100% of pts with bacteremia. There were no instances of nephrotoxicity or hepatotoxicity. Estimated cost avoidance per pt was &5210 and &1652 if traditional IV therapy was completed in the hospital and SNF, respectively. Because the alternative therapy to dalba could not be predicted, these costs were not included in analysis but likely would have increased calculated cost avoidance. Conclusion Dalba was associated with a relatively high success rate for the treatment of off-label indications and may have less total costs than traditional IV ABX. Disclosures James Johnson, PharmD, FLGT (Shareholder) Vera Luther, MD, Nothing to disclose

scholarly journals 614. Long-Acting Lipoglycopeptides for the Treatment of Bone and Joint Infections and Bacteremia in Infectious Disease Outpatient Infusion Clinics

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S367-S367
Author(s):  
Brian S Metzger ◽  
Richard C Prokesch ◽  
Jorge R Bernett ◽  
Richard M Mandel ◽  
Ramesh V Nathan ◽  
...  
Keyword(s):  
Real World ◽  
Clinical Success ◽  
Committee Member ◽  
Joint Infection ◽  
Median Number ◽  
Success Rates ◽  
Real World Data ◽  
Gram Positive ◽  
Prosthetic Joint ◽  
Long Acting

Abstract Background Long-acting lipoglycopeptides (LGPs) are approved for the treatment of acute bacterial skin and skin-structure infections. Broad Gram-positive coverage and weekly dosing regimens are useful for other diagnoses, but real-world data supporting such use are sparse. We review our experience of dalbavancin and oritavancin for the treatment of bone and joint infection (BJI) and bacteremia (BAC) in outpatient infusion clinics (OICs). Methods We conducted a multicenter, retrospective, observational cohort study of patients (pts) receiving long-acting LGPs in OICs over 2 yrs from 2018-2019 for BJI and BAC. Data collected included demographics, diagnosis, dosing regimen, microbiology, clinical outcomes, and adverse events (AEs). Clinical success, defined as resolution of infection with continued oral antibiotics allowed, was assessed at the next follow-up visit. Worsening infection, the need for additional intravenous therapy, and discontinuations during therapy were deemed non-successful. Results We identified 70 pts (mean age: 64±16 years, 53% male) from 25 OICs, who received dalbavancin (n=50), oritavancin (n=19) and both (n=1). BJI accounted for 55 (79%) with 31 osteomyelitis, 9 bursitis, 7 prosthetic joint, 7 septic arthritis and 1 tenosynovitis. BAC was the primary diagnosis in 15 (21%) and sources were 6 device, 2 lower respiratory tract, 2 urinary tract and 5 unknown. 46% of pts were treated in the OIC without prior hospitalization. 72 Gram-positive isolates were obtained from 67 pts, with Staphylococcus aureus predominant (42/72, 58%), including methicillin-resistant (26/72, 36%) and methicillin-susceptible isolates (16/72, 22%). Median number of doses administered were 2 [IQR 1-2] in BJI and 1 in BAC [IQR 1-2]. Overall clinical success was 86% (57/66), with 4 non-evaluable. BJI had 85% success (44/52), with 90% in osteomyelitis (28/31), 50% in prosthetic joint (3/6) and 87% (13/15) in the others. Clinical success was 93% (13/14) in BAC. Three pts (4%) on dalbavancin experienced mild AEs, none resulting in discontinuation of therapy. Conclusion This multicenter real-world study of long-acting LGPs demonstrates safety and high clinical success rates in BJI and BAC. Our experience suggests a role for use of these agents in treatment of BJI and BAC in the outpatient setting. Disclosures Brian S. Metzger, MD, MPH, Allergan (Speaker’s Bureau)Cumberland (Speaker’s Bureau)Melinta (Speaker’s Bureau) Ramesh V. Nathan, MD, FIDSA, Merck & Co. (Other Financial or Material Support, Grant Steering Committee Member) Lucinda J. Van Anglen, PharmD, Merck & Co. (Grant/Research Support)

scholarly journals Implant materials and prosthetic joint infection: the battle with the biofilm

2019 ◽  
Vol 4 (11) ◽  
pp. 633-639 ◽  
Author(s):  
Donald J. Davidson ◽  
David Spratt ◽  
Alexander D. Liddle
Keyword(s):  
Prosthetic Joint Infection ◽  
Clinical Medicine ◽  
Clinical Success ◽  
Joint Infection ◽  
Treatment Strategies ◽  
Surface Coatings ◽  
Implant Surface ◽  
Prosthetic Joint ◽  
Significant Burden ◽  
New Treatment

Prosthetic joint infection (PJI) is associated with poor clinical outcomes and is expensive to treat. Although uncommon overall (affecting between 0.5% and 2.2% of cases), PJI is one of the most commonly encountered complications of joint replacement and its incidence is increasing, putting a significant burden on healthcare systems. Once established, PJI is extremely difficult to eradicate as bacteria exist in biofilms which protect them from antibiotics and the host immune response. Improved understanding of the microbial pathology in PJI has generated potential new treatment strategies for prevention and eradication of biofilm associated infection including modification of implant surfaces to prevent adhesion of bacteria. Much research is currently ongoing looking at different implant surface coatings and modifications, and although most of this work has not translated into clinical medicine there has been some early clinical success.Cite this article: EFORT Open Rev 2019;4:633-639. DOI: 10.1302/2058-5241.4.180095

scholarly journals Salvage Debridement, Antibiotics and Implant Retention (“DAIR”) With Local Injection of a Selected Cocktail of Bacteriophages: Is It an Option for an Elderly Patient With Relapsing Staphylococcus aureus Prosthetic-Joint Infection?

2018 ◽  
Vol 5 (11) ◽  
Author(s):  
Tristan Ferry ◽  
Gilles Leboucher ◽  
Cindy Fevre ◽  
Yannick Herry ◽  
Anne Conrad ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Prosthetic Joint Infection ◽  
Clinical Success ◽  
Joint Infection ◽  
Salvage Treatment ◽  
Local Injection ◽  
Scientific Evaluation ◽  
Potential Clinical Benefit ◽  
Prosthetic Joint ◽  
Implant Retention

Abstract Local injection of a bacteriophages mix during debridement, antibiotics and implant retention (“DAIR”) was performed to treat a relapsing Staphylococcus aureus chronic prosthetic joint infection (PJI). This salvage treatment was safe and associated with a clinical success. Scientific evaluation of the potential clinical benefit of bacteriophages as antibiofilm treatment in PJI is now feasible and required.

First reported case of Weissella confusa abundance in the lung microbiota of a critically ill trauma patient with acute respiratory distress syndrome - caution warranted in the use of the Weissella genus as a probiotic

2020 ◽  
Author(s):  
Sandeep Chakraborty
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Critically Ill ◽  
Distress Syndrome ◽  
Joint Infection ◽  
Starter Cultures ◽  
Trauma Patients ◽  
Virulence Determinants ◽  
Prosthetic Joint

Weissella strains are currently being used for biotechnological and probiotic purposes [1]. While, Weissella hellenica found in flounder intestine had probiotic effects [2], certain species from this genus are opportunistic pathogens in humans. Apart from being implicated in disease in farmed rainbow trout [3], Weissella has been found to cause the following disease in humans.1. endocarditis [4,5]2. bacteraemia [6]3. prosthetic joint infection [7]Whole genome sequences ‘find several virulence determinants such as collagen adhesins, aggregation sub- stances, mucus-binding proteins, and hemolysins in some species’, as well as antibiotic resistance-encoding genes [8]. Caution is warranted in selecting of Weissella strains as starter cultures or probiotics, if at all, since the other option, Lactobacillus, are rarely involved in human disease.Here, the analysis of the lung microbiota in critically ill trauma patients suffering from acute respiratory distress syndrome [9] shows (Accid:ERR1992912) shows complete colonization of Weissella (Fig 1). While, the study mentions ‘significant enrichment of potential pathogens including Streptococcus, Fusobacterium, Prevotella, Haemophilus and Treponema’, there is no reference to the Weissella genus. The percentages of Weissella strains are :confusa=81, soli=7 ,hellenica=5 ,diestrammenae=2. I believe this is the first reported case of Weissella causing ARDS in humans.

scholarly journals Long-Term Use of Tedizolid in Osteoarticular Infections: Benefits among Oxazolidinone Drugs

Antibiotics ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 53
Author(s):  
Eva Benavent ◽  
Laura Morata ◽  
Francesc Escrihuela-Vidal ◽  
Esteban Alberto Reynaga ◽  
Laura Soldevila ◽  
...  
Keyword(s):  
Drug Interaction ◽  
Joint Infection ◽  
Diabetic Foot Infections ◽  
Osteoarticular Infections ◽  
Prosthetic Joint ◽  
Implant Retention ◽  
Lower Drug ◽  
Drug Drug Interaction ◽  
Staphylococcus Spp

Background: To evaluate the efficacy and safety of long-term use of tedizolid in osteoarticular infections. Methods: Multicentric retrospective study (January 2017–March 2019) of osteoarticular infection cases treated with tedizolid. Failure: clinical worsening despite antibiotic treatment or the need of suppressive treatment. Results: Cases (n = 51; 59% women, mean age of 65 years) included osteoarthritis (n = 27, 53%), prosthetic joint infection (n = 17, 33.3%), and diabetic foot infections (n = 9, 18%); where, 59% were orthopedic device-related. Most frequent isolates were Staphylococcus spp. (65%, n = 47; S. aureus, 48%). Reasons for choosing tedizolid were potential drug-drug interaction (63%) and cytopenia (55%); median treatment duration was 29 days (interquartile range -IQR- 15–44), 24% received rifampicin (600 mg once daily) concomitantly, and adverse events were scarce (n = 3). Hemoglobin and platelet count stayed stable throughout treatment (from 108.6 g/L to 116.3 g/L, p = 0.079; and 240 × 109/L to 239 × 109/L, p = 0.942, respectively), also in the subgroup of cases with cytopenia. Among device-related infections, 33% were managed with implant retention. Median follow-up was 630 days and overall cure rate 83%; among failures (n = 8), 63% were device-related infections. Conclusions: Long-term use of tedizolid was effective, showing a better safety profile with less myelotoxicity and lower drug-drug interaction than linezolid. Confirmation of these advantages could make tedizolid the oxazolidinone of choice for most of osteoarticular infections.

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