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Real-World Use of Dalbavancin for Treatment of Soft Tissue and Bone Infection in Children: Safe, Effective and
Désirée Caselli1, Marcello Mariani2, Claudia Colomba3,4
1Infectious Diseases, Children's Hospital Giovanni XXIII, Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari, 70124 Bari, Italy.
Insights
Dalbavancin offers a safe and effective treatment for acute bacterial skin and skin structure infections (ABSSSI) and bone infections in children. This lipoglycopeptide antibiotic demonstrated feasibility and shortened hospital stays in pediatric patients.
Area of Science:
- Pediatric Infectious Diseases
- Antimicrobial Therapy
- Pharmacology
Background:
- Acute bacterial skin and skin structure infections (ABSSSI) and osteoarticular infections pose significant health challenges, particularly those caused by gram-positive bacteria.
- Dalbavancin, a second-generation lipoglycopeptide, has a prolonged half-life, suggesting potential utility in managing these infections.
Purpose of the Study:
- To evaluate the safety, feasibility, and effectiveness of dalbavancin in treating pediatric patients with ABSSSI and osteoarticular infections.
- To assess the impact of dalbavancin on hospital stay duration in this patient population.
Main Methods:
- A retrospective study involving 31 children and adolescents treated with dalbavancin across five Italian pediatric centers between October 2019 and September 2023.
- Analysis of patient demographics, infection types, prior antibiotic treatments, dalbavancin dosage and administration, adverse events, and treatment outcomes.
Main Results:
- Dalbavancin was administered for bone and joint infections (39%), ABSSSI (42%), and complicated ABSSSI (19%), with Gram-positive bacteria, including MRSA, identified in several cases.
- The median time to dalbavancin initiation was 18 days, with a median hospital stay of 16 days. A significant finding was the median time to discharge of only 1 day after the first dalbavancin dose.
- Treatment was well-tolerated, with only four doses associated with adverse events (extravasation, headache, vomiting, systemic reaction). No treatment failures or adverse effects were reported during a median two-month follow-up for 29 patients.
Conclusions:
- Dalbavancin is a safe, feasible, and effective treatment option for acute bacterial infections in pediatric patients.
- The use of dalbavancin can significantly shorten hospital stays for children and adolescents requiring treatment for ABSSSI and osteoarticular infections.
Abstract:
Acute bacterial skin and skin structure infections (ABSSSI) and osteoarticular infections compound the burden of morbidity, mortality and prolonged hospitalizations among gram-positive infections. Dalbavancin, a second-generation, intravenous lipoglycopeptide, due to its prolonged half-life, can be a valuable alternative in their treatment when administered as inpatient treatment at the price of an extended hospital stay. Between October 2019 and September 2023, 31 children and adolescents were treated with dalbavancin because of bone and joint infections (n = 12 patients, 39%), ABSSSI (n = 13 patients, 42%), mainly for the limbs, facial cellulitis or complicated ABSSSI (n = 6 patients, 19%), at five Italian pediatric centers. Microbiological study provided gram-positive bacterial isolate in 16 cases, in 11 cases from a positive blood culture; 9 of them were MRSA. Twenty-five patients were initially treated with a different antibiotic therapy: beta-lactam-based in 18 patients (58%), glycopeptide-based in 15 patients (48%) and daptomycin in 6 (19%). The median time that elapsed between admission and start of dalbavancin was 18 days. A total of 61 doses of dalbavancin were administered to the 31 patients: 16 received a single dose while the remaining 15 patients received between two (n = 9) and nine doses. The frequency of administration was weekly in five cases or fortnightly in nine patients. Median length of stay in hospital was 16 days. Median time to discharge after the first dose of dalbavancin was 1 day. Treatment was very well-tolerated: of the 61 administered doses, only four doses, administered to four patients, were associated with an adverse event: drug extravasation during intravenous administration occurred in two patients, with no sequelae; however, in two patients the first administration was stopped soon after infusion start: in one (ID #11), due to headache and vomiting; in another (ID #12) due to a systemic reaction. In both patients, drug infusion was not repeated. None of the remaining 29 patients reported treatment failure (resistant or recurrent disease) or an adverse effect during a median follow-up time of two months. The use of dalbavancin was safe, feasible and also effective in shortening the hospital stay in children and adolescents.
