Efficacy and safety of weekly dalbavancin therapy for catheter-related bloodstream infection caused by gram-positive pathogens

Background. Catheter-related bloodstream infections (CR-BSIs) are associated with substantial mortality, prolongation of hospital stay, and increased cost of care. Dalbavancin, a new glycopeptide antibiotic with unique pharmacokinetic properties that have allowed clinical development of a weekly dosing regimen, possesses excellent activity against clinically important gram-positive bacteria, suggesting utility in the treatment of patients with CR-BSIs. Methods. A phase 2, open-label, randomized, controlled, multicenter study of 75 adult patients with CR-BSIs compared treatment with intravenous dalbavancin, administered as a single 1000-mg dose followed by a 500-mg dose 1 week later, with intravenous vancomycin, administered twice daily for 14 days. Gram-positive bacteria isolated in this study included coagulase-negative staphylococci ( CoNS) and Staphylococcus aureus, including methicillin-resistant S. aureus ( MRSA). Results. Infected patients who received weekly dalbavancin (n = 33) had an overall success rate ( 87.0%; 95% confidence interval [CI], 73.2% - 100.0%) that was significantly higher than that of those who received vancomycin (n = 34) (50.0%; 95% CI, 31.5% - 68.5%). Adverse events and laboratory abnormalities were generally mild and were comparable for the 2 drugs. Conclusions. Dalbavancin thus appears to be an effective and well-tolerated treatment option for adult patients with CR-BSIs caused by CoNS and S. aureus, including MRSA.