Dalbavancin to Treat Infected Massive Endoprostheses: A Case Report and Cost Comparison Analysis

Area of Science:

• Orthopedic surgery
• Infectious diseases
• Pharmacology

Background:

• Infected massive endoprosthetic replacements pose significant treatment challenges.
• Limited safe and convenient antimicrobial options exist for outpatient management.
• Two-stage surgical protocols are often necessary for limb salvage.

Observation:

• A case of infected massive endoprosthetic replacement was successfully managed.
• Treatment involved a two-stage surgical intervention.
• Off-label dalbavancin was administered as a key component of the antimicrobial regimen.

Findings:

• Successful eradication of infection and limb salvage were achieved.
• Dalbavancin provided effective treatment in an outpatient setting.
• The use of dalbavancin avoided the need for daily dosing, improving patient compliance.

Implications:

• This case highlights the potential utility of off-label dalbavancin in managing complex orthopedic device infections.
• Two-stage surgery combined with novel antibiotic strategies can be effective for infected endoprostheses.
• Outpatient parenteral antimicrobial therapy (OPAT) can be expanded with long-acting agents like dalbavancin.