Dalbavancin may be effective treatment for gram-positive PJI
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Key takeaways:
- Patients had no drug-related complications with dalbavancin.
- Results showed 89% of patients were infection free at final follow-up.
Results presented at the Musculoskeletal Infection Society Annual Meeting showed dalbavancin may be an effective antibiotic for treatment of gram-positive periprosthetic joint infections.
“Overall, our experience with dalbavancin has been mostly positive. We have reasonable success rates in difficult situations,” Alberto V. Carli, MD, orthopedic surgeon at Hospital for Special Surgery, said in his presentation. “It is an appealing choice for patients who have had side effects to known medications for these organisms or if they have contraindications.”
Carli and colleagues retrospectively analyzed data from 18 patients who received IV dalbavancin for treatment of PJI after an orthopedic procedure. Outcomes measured included the 2019 Musculoskeletal Infection Society (MSIS) working group definitions of PJI treatment success, as well as the incidence of drug-related adverse events.
The MSIS definition of PJI treatment success is categorized by infection control without continued antibiotics (tier 1); infection control with suppressive antibiotics (tier 2); need for reoperation, revision or spacer retention (tier 3); and death (tier 4).
Although there were no complications related to dalbavancin, Carli said there were instances of patient death and above knee amputation in the cohort, which he attributed to “the reality of these complex cases.” According to the abstract, 16 patients (89%) were infection free at final follow-up.
In terms of the success of dalbavancin, Carli said two-thirds of patients met the MSIS tier 1 or tier 2 working group definitions of success.
“The hope now is to try and do a natural case control with standard of care, but outcomes and benchmarks are important,” Carli said.
He added, “Cost is obviously a big issue in terms of who pays for this attractive but expensive medication.”
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Carli AV, et al. Paper 1256. Presented at: Musculoskeletal Infection Society Annual Meeting; Aug. 2-3, 2024; Durham, North Carolina (hybrid meeting).
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