Dalbavancin for infective endocarditis: a single centre experience

Abstract

Infective endocarditis (IE) is a life-threatening disease, mostly caused by gram-positive cocci, needing a 4–6 weeks antibiotic course. Dalbavancin is a lipoglycopeptide active on gram-positive microorganisms, with a unique pharmacokinetic profile. We describe our experience with dalbavancin to complete the intravenous antibiotic regimen for difficult-to-treat IE cases due to gram-positive bacteria. We treated 10 severely ill patients, each presenting several comorbidities. Seven patients were microbiologically cured from IE, but two patients experienced IE relapse due to the same microrganism. Short-term mortality after dalbavancin was nil, but late mortality (within 1 year of hospital discharge) was 60%. No death was related to dalbavancin therapy. Treatment was generally well tolerated. Dalbavancin may be an option to complete IE treatment in selected cases, once blood culture clearance and improvement of clinical conditions under standard therapy is reached, allowing shortening of hospitalization.

Keywords:

• Hospitalization;
• treatment duration;
• mortality
• gram-positive bacteria;
• relapse;
• adverse events;
• early discharge

Acknowledgements

Authors would like to thank the AORN Ospedali dei Colli for support in the conduction of this study.

Declaration of interest

EDM received grant support and personal fees, outside of this work, from Roche, Pfizer, MSD, Angelini, Bio-Merieux, Abbvie, Nordic Pharma, Sanofi-Aventis, Medtronic and DiaSorin. RZ and RA received personal fees, outside of this work, from Nordic Pharma.

Additional information

Notes on contributors

Emanuele Durante-Mangoni

Emanuele Durante Mangoni, MD PhD, is an associate professor of Internal Medicine in the University of Campania ‘L. Vanvitelli’ and director of Unit of Infectious and Transplant Medicine, ‘V. Monaldi’ teaching hospital, Naples, Italy. Head of a research laboratory with know-how in molecular biology and protein assays, he was a Research Fellow at the Harvard Medical School, Beth Israel Deaconess Medical Center in Boston, and the Imperial College Medical School in London. Author of >130 full papers on peer-reviewed International journals with impact factor, with an Hirsch index of 36 and >4000 citations. Scientific Board Member of Clinical Microbiology & Infection (2016- ), Emanuele is acting as the scientific secretary of the International Society for Cardiovascular Infectious Diseases (2017–2021). He is an investigator in several international and national studies funded by the US NIH, Italian Medicines Agency, the EU Commission and the Italian Ministries of Health and of Research.

Filomena Boccia

Filomena Boccia is a resident at the Internal Medicine School of the University of Campania “L. Vanvitelli” Italy. She took part in a Professional Exchange Program at the Cardiothoracic Surgery Department of PTE-KK (Pecs, Hungary). She is member of the Italian Society of Internal Medicine (SIMI) and of the Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI). She conducts clinical activity at the Unit of Infectious & Transplant medicine, University of Campania “L. Vanvitelli”, AORN dei Colli, Monaldi Hospital, Naples.

Maria Paola Ursi

Maria Paola Ursi is a Resident in Internal Medicine of the University of Campania “L. Vanvitelli”, Naples, Italy, since Nov. 2016. Member of the Italian Society of Internal Medicine (SIMI) and member of the Italian Society of Emergency Medicine (SIMEU). She was Research Fellowship in the Department of Cardiology at St Thomas' Hospital, London, UK from 1st March 2018 to 31st August 2018. Author of 8 publications. She conducts clinical activity at the Unit of Infectious & Transplant Medicine, University of Campania “L. Vanvitelli”, AORN dei Colli, Monaldi Hospital, Naples.

Arta Karruli

Arta Karruli, MD is a PHD student in the University of Campania “L. Vanvitelli” Italy. Graduated in Medicine School in two Universities, University of Medicine in Tirana, Albania and University of Milan “UNIMI”, Italy. Specialized in Infectious Diseases. Research fellow in the Department of Infectious Diseases for one year in University of Milan-Bicocca, Italy. The principal research lines concern in endocarditis, tropical infections, multidrug resistant infections and infection in heart transplanted patients.

Roberto Andini

Roberto Andini, MD in the Infectious and Transplantation Medicine ward, Azienda dei Colli, Monaldi Hospital. Internal medicine specialist. Main consultant in Internal Medicine and Infectious Diseases in the Monaldi Hospital. Author of over 20 papers in international journals, over 100 abstracts and posters. Main fields of research: infections sustained by MDR germs, pathologies of solid organ recipient transplant patient, hepatology, viral infection.

Maria Galdo

Maria Galdo, degree in pharmacy and specialization in hospital pharmacy. Member of the “Hospital Infections Committee” and of the “Clinical Risk Commission” at AORN dei Colli (Naples) and regional member of the “Permanent multidisciplinary technical table on Antimicrobial Stewardship”. She was from 2013 to 2020 regional councilor of “Italian hospital pharmacy Society” for the hospital area and clinical trials.

Rosa Zampino

Rosa Zampino, MD PhD, is a researcher of Internal Medicine in the University of Campania ‘L. Vanvitelli’ Italy, teaching, as aggregate professor, clinical methodology and internal medicine. She was Research Fellow at the Imperial College Medical School in London. Her principal research lines concern in hepatology, severe infection and monitoring and treatment of heart transplanted patients. Author of about 100 publications with an Hirscprih index of 26 and > 2300 citations. She is an investigator in several international and national studies. She conducts clinical activity at the Unit of Infectious & Transplant Medicine, University of Campania “L. Vanvitelli”, AORN dei Colli, Monaldi Hospital, Naples. and is responsible of an office of Internal Medicine and Hepatology.