Dalbavancin treatment for prosthetic joint infections in real-life: a national cohort study and literature review.

Abstract Background Dalbavancin is a long-lasting lipoglycopeptide active against gram-positive bacteria, especially methicillin-resistant staphylococci. Few data are available on dalbavancin use for prosthetic joint infection (PJI) treatment. We aimed to describe a cohort of patients treated for PJI with dalbavancin and review the literature concerning this condition. Methods From 1 st June 2017 to 1 st January 2019, all adult patients with PJI from the French dalbavancin national cohort were included. We collected clinical and microbiological characteristics and outcome, through a standardised questionnaire. Clinical cure was defined as the absence of clinical signs of infection at last visit. Failure was a composite criterion defined by: persistence or reappearance of signs of infection; and/or switch to suppressive antibiotic treatment; and/or death from infection. The literature review was performed on Pubmed. Results Seventeen patients were included. Bacteria were identified in 16 cases: Staphylococcus aureus (n=10), including methicillin-resistant S. aureus (n=1), and coagulase negative staphylococci (n=10), including methicillin-resistant S. epidermidis (n=4). Sixteen (94.1%) patients had received antibiotic therapy prior to dalbavancin use with a mean of 2.2±1.3 lines. Clinical cure was obtained in 8/17 patients after a median follow-up of 299.0 (IQR 97.0-476.0) days. We reviewed all cases of PJI treated with dalbavancin available in literature and the overall clinical cure was estimated at 73.1%. Conclusion Our study and literature data suggest that the use of dalbavancin in PJI could be considered, even in salvage therapy. Dalbavancin appears to be a safe and easy treatment for patients with staphylococcal PJIs