Table 1.
Characteristics of patients with Dalbavancin suppressive therapy with resistance profiles of the isolated organisms
| Patient 1 | Patient 2 | Patient 3 | Patient 4 | |
|---|---|---|---|---|
| Gender/Age | M/81 ys | M/59 ys | M/67 ys | M/80 ys |
| Isolated pathogen in blood culture | MRSA | E. faecium | E. faecalis | E. faecalis |
| Source of bacteremia | Prosthetic valve endocarditis | LVAD infection | LVAD infection | TAVI endocarditis |
| Implantation of intravascular prothesis/device | 2001 | June 2018 | January 2018 | May 2016 |
| Clinical events of note prior to the onset of the index bacteremia | Admission to another hospital with fever and chills, MRSA bacteremia |
History of NEM Admission with bowel obstruction/laparotomy/adhesiolysis; C. diff. colitis |
History of hairy cell leukemia Admission with fever and chills, E. faecalis bacteremia (unknown source) |
Several admissions with E. faecalis bacteremia, diagnosis of TAVI endocarditis (TEE initially negative) |
| Index bacteremia (calendar date = d1) | May 2018 (d1) | October 2018 (d1) | May 2019 (d1) | August 2019 (d1) |
| Initial management of index bacteremia and events up to initiation of dalbavancin | Vancomycin plus rifampicin, later daptomycin plus rifampicin for 6 weeks, cessation of antibiotic therapy on d50 | Vancomycin/daptomycin, then switch to dalbavancin | Vancomycin, due to severe penicillin allergy; then chronic suppressive therapy with dalbavancin |
Vancomycin and piperacillin (ampicillin/amoxicillin allergy) |
| Complications/side effects | Readmission on d63 with recurrence of MRSA bacteremia, treatment with vancomycin, then switch to linezolid p.o., followed by dalbavancin |
C. diff. colitis with acute renal failure, no recurrence despite continuation of dalbavancin, No relevant side effects |
Recurrence of E. faecalis bacteremia on d161, treatment with vancomycin and then again switch to dalbavancin |
Recurrence of bacteremia under oral suppressive therapy with moxifloxacin/rifampicin Mild rash (association to dalbavancin debatable) |
| Start/end Dalbavancin | d123/d130 (given only twice) | d41/still ongoing | d28/d210 | d98/d213 |
| Follow up / outcome | Death on about d135 due to heart failure | Dalbavancin still ongoing | Readmission on d214 with stroke, BC sterile, death due to complications of stroke on d228 |
Due to general worsening of condition treatment change to best supportive care Death on d223 |
| Dalbavancin regimen | LD 1000 mg, 375 mg weekly | LD 1000 mg, 500 mg weekly | LD 1000 mg, 500 mg weekly | LD 1500 mg, 1000 mg biweekly |
| Susceptibility testing [MIC (mg/L)] | ||||
| Ampicillin | R | R [> 8] | S [< = 2] | S [< = 2] |
| Amox./Clav | R | R | S | S |
| Ceftriaxone | R | R | R | R |
| Pip/Taz | R | R | S | S |
| Meropenem | R | R | R | R |
| Ciprofloxacin | R [4] | X [0.5] | ||
| Moxifloxacin | R [1] | X [1] | ||
| Rifampicin | R [> 1] | R | ||
| Cotrimoxazol | R [> 4/76] | R | R | R |
| Clindamycin | R [1] | R | R | S [1] |
| Linezolid | S [< 0.5] | S [1] | S [2] | S [1] |
| Vancomycin | S [1] | S [1] | S [1] | S [< = 0.5] |
| Daptomycin | R [2] | S [4] | S [4] | |
| Tetracyclin | I [2] |
The SIR category of antimicrobial agents without MIC value is inferred from an indicator substance or represents intrinsic resistance
M male, ys years, LVAD left ventricular assist device, TAVI transcatheter aortic valve implantation, NEN neuroendocrine neoplasm, LD loading dose, MIC minimal inhibitory concentration, S susceptible, R resistant X no EUCAST break-points available, breakpoints were derived from the POET study [12]