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Updated: Jun 13, 2025
A Reference Broth Microdilution Method for Dalbavancin In Vitro Susceptibility Testing of Bacteria that Grow Aerobically
Published on: September 9, 2015
Clinical, microbiological, and laboratory predictors of on- and off-label dalbavancin treatment failure
Maria Mazzitelli1, Daniele Mengato2, Vincenzo Scaglione1
1Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy.
Objectives:
Data about risk factors for treatment failure (TF) to dalbavancin are lacking. Our aim was to investigate the clinical, microbiological, and laboratory predictors of TF in both on- and off-label dalbavancin treatments.
Methods:
We included all patients who received at least one dose of dalbavancin at our centre from January 2018 to June 2024 and with available data on follow-up, collecting all clinical and laboratory parameters. TF was defined as the need for readmission, emergency department access, or death within 90 d after treatment. Factors correlating with TF and mortality rate were assessed using multivariable analyses and Kaplan-Meier curves.
Results:
Three hundred fifty-one patients were included, mostly men (60.9 %), median age of 64 years (interquartile range [IQR] = 49.5-75.5), 55.3 % receiving dalbavancin in the emergency department/outpatient setting, and 44.7 % for early discharge, in 54.9 % cases as off-label. The main off-label indications were osteomyelitis, prosthetic infections, and endocarditis (17.1 %, 8.3 %, and 7.7 %). In 53.3 % of the cases, a microbiological isolate was available (Methicillin-resistant Staphylococcus aureus [MRSA] in 49.2 % of cases). Overall, the TF rate was 19.4 %. Overall, multivariable analysis showed that intravenous (IV) drug use (hazard ratio [HR] = 7.99, P < 0.001), diabetes (HR = 6.1, P < 0.001), obesity (HR = 4.5, P < 0.001), cancer (HR = 5.3, P < 0.001), HIV (HR = 4.88, P < 0.001), levels of CRP at dalbavancin treatment initiation (HR = 1.01, P < 0.001, and HR = 0.72, P = 0.02) were associated with TF. Additionally, the duration of IV antibiotic therapy before being discharged influenced outcomes in the off-label group (HR = 0.52, P = 0.02).
Conclusions:
The observed TF rate was high, particularly in off-label uses and among individuals with multiple comorbidities or IV drug use. More evidence is needed to better define the optimal patient profile for effective dalbavancin treatment.
