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Can dalbavancin be used as a catheter lock solution?

Cristina Díaz-Ruíz1, Beatriz Alonso2,3, Emilia Cercenado2

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|May 18, 2018
PubMed
Summary

Dalbavancin combined with heparin shows significant activity against MRSA biofilms, outperforming vancomycin. This combination is a promising catheter lock solution for managing catheter-related bloodstream infections at home for up to seven days.

Keywords:
Catheter-related bloodstream infectiondalbavancinlock therapyvancomycin

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Area of Science:

  • Microbiology
  • Infectious Diseases
  • Pharmacology

Background:

  • Dalbavancin is approved for skin infections but its potential as a catheter lock solution for bloodstream infections is unexplored.
  • Catheter-related bloodstream infections pose a significant clinical challenge, necessitating effective management strategies.
  • Methicillin-resistant Staphylococcus aureus (MRSA) and Staphylococcus epidermidis (MRSE) are common pathogens in device-associated infections.

Purpose of the Study:

  • To evaluate the stability and antimicrobial activity of dalbavancin, alone and with heparin, against MRSA and MRSE biofilms.
  • To compare the efficacy of dalbavancin-heparin combination with vancomycin-heparin against these resistant bacterial biofilms.
  • To assess the potential of dalbavancin as a catheter lock solution for preventing and treating catheter-related bloodstream infections.

Main Methods:

  • An in vitro 96-well plate model was used to generate 24-hour biofilms of MRSA and MRSE.
  • Biofilms were treated with dalbavancin (0.128 mg/ml) or vancomycin (5 mg/ml), alone and in combination with heparin (60 IU).
  • Reductions in metabolic activity, biomass, bacterial load, and cell viability were quantified and compared.

Main Results:

  • Dalbavancin plus heparin significantly reduced metabolic activity in MRSA biofilms compared to vancomycin plus heparin (90.0% vs 35.0%, P=0.006).
  • For other measured variables, the dalbavancin-heparin combination was not inferior to vancomycin-heparin against both MRSA and MRSE.
  • Dalbavancin demonstrated inherent activity against both MRSA and MRSE biofilms.

Conclusions:

  • Dalbavancin exhibits significant activity against MRSA and MRSE biofilms.
  • The combination of dalbavancin and heparin presents a promising option for catheter lock solutions.
  • This combination offers the potential for convenient home-based catheter management for up to seven days.