Real-World Use of Dalbavancin in Diabetic Foot Osteomyelitis: PEDDAL Study

Background: Data on antibiotic treatment for diabetic foot osteomyelitis are limited. This study aims to describe the real-world effectiveness and safety of dalbavancin in treating deep diabetic foot infections. Methods: A retrospective, observational, multicenter study was conducted in nine Spanish hospitals and one Irish hospital. Patients with diabetic foot osteomyelitis treated with dalbavancin were included. Data on demographics, clinical characteristics, microbiology, antibiotic regimens, adverse events, and clinical outcomes were analyzed. Results: Among 136 patients, 76% were male, with a mean age of 69 ± 12 years. Renal insufficiency was observed in 32%, and 6% required renal replacement therapy. Based on the McCabe scale, 70% of patients had a rapidly or ultimately fatal disease. Polypharmacy was noted in 83%, and 60% of infections were moderate. Dalbavancin was primarily used as second-line therapy (92%). The cure rate was 80.9% (95% CI: 73.5-86.6%), achieved after a median of two doses. Patients receiving dalbavancin as first-line therapy had a cure rate of 86%, comparable to 80% in second-line therapy, with no significant differences. Surgical interventions were required in 72% of cases, with minor amputations performed in 40% of patients. Polymicrobial infections were common (55%), and methicillin-resistant Staphylococcus aureus was identified in 26% of cases. Adverse events occurred in 5% of patients. Chronic kidney disease was the sole independent risk factor for therapeutic failure (IRR 0.80, 95% CI: 0.64-1.00, p = 0.045). Conclusions: Dalbavancin is effective and safe for treating diabetic foot osteomyelitis, including in complex patients with resistant microorganisms.