DALBACEN cohort: dalbavancin as consolidation therapy in patients with endocarditis and/or bloodstream infection produced by gram-positive cocci
DALBACEN cohort: dalbavancin as consolidation therapy in patients with endocarditis and/or bloodstream infection produced by gram-positive cocci
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DOI：
10.1186/s12941-019-0329-6
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发表时间：
2019-10-19
影响因子：
5.7
通讯作者：
Pasquau, Juan
中科院分区：
文献类型：
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作者：
Hidalgo-Tenorio, Carmen;Vinuesa, David;Pasquau, Juan
目的 分析达巴万星 (DBV) 在临床实践中作为巩固治疗治疗革兰氏阳性球菌 (GPC) 引起的血流感染 (BSI) 和/或感染性心内膜炎 (IE) 的有效性，以及其安全性和药物经济学影响。方法 对接受至少一剂 DBV 的 GPC 产生的 IE 和/或 BSI 住院患者进行了一项多中心、观察性和回顾性研究。在住院期间、3个月和1年评估临床反应。结果 83 例患者入组，中位年龄 73 岁； 73.5%为男性； 59.04% 患有 BSI，49.04% 患有 IE（44.04% 为人工瓣膜 IE，32.4% 为天然 IE，23.5% 为起搏器导线）。最常见的微生物是 BSI 中的金黄色葡萄球菌 (49%) 和 IE 中的凝固酶阴性葡萄球菌 (44.1%)。所有IE患者均在医院临床治愈； 12 个月时，失访率为 2.9%，与 IE 无关的死亡率为 8.8%，治疗失败率为 2.9%。 DBV 治疗 IE 的有效率为 96.7%。 BSI的临床治愈率在住院期间和3个月时均为100%；随访期间无复发或死亡病例。没有患者因不良事件而停止治疗。 BSI 节省的住院时间为 636 天（315,424.20 欧元），IE 节省的住院时间为 557 天（283,187.45 欧元）。结论 DBV 对于临床稳定的 IE 和/或 BSI 患者来说是一种有效的巩固抗生素治疗。由于该药物的药代动力学/药效学特征，事实证明这是一种具有成本效益的治疗方法，可以减少住院时间。
Objectives To analyse the effectiveness of dalbavancin (DBV) in clinical practice as consolidation therapy in patients with bloodstream infection (BSI) and/or infective endocarditis (IE) produced by gram-positive cocci (GPC), as well as its safety and pharmacoeconomic impact. Methods A multicentre, observational and retrospective study was conducted of hospitalised patients with IE and/or BSI produced by GPC who received at least one dose of DBV. Clinical response was assessed during hospitalization, at 3 months and at 1 year. Results Eighty-three patients with median age of 73 years were enrolled; 73.5% were male; 59.04% had BSI and 49.04% IE (44.04% prosthetic valve IE, 32.4% native IE, 23.5% pacemaker lead). The most frequently isolated microorganism was Staphylococcus aureus in BSI (49%) and coagulase-negative staphylococci in IE (44.1%). All patients with IE were clinically cured in hospital; at 12 months, there was 2.9% loss to follow-up, 8.8% mortality unrelated to IE, and 2.9% therapeutic failure rate. The percentage effectiveness of DBV to treat IE was 96.7%. The clinical cure rate for BSI was 100% during hospital stay and at 3 months; there were no recurrences or deaths during the follow-up. No patient discontinued treatment for adverse events. The saving in hospital stay was 636 days for BSI (315,424.20euro) and 557 days for IE (283,187.45euro). Conclusions DBV is an effective consolidation antibiotic therapy in clinically stabilized patients with IE and/or BSI. It proved to be a cost-effective treatment, reducing the hospital stay, thanks to the pharmacokinetic/pharmacodynamic profile of this drug.