Evaluating the Use of Dalbavancin for Off-Label Indications.

(1) Background: Dalbavancin is a long-acting lipoglycopeptide antibiotic approved for skin and soft-tissue infections. Post-marketing experience suggests dalbavancin is being used for off-label indications that normally require long-term intravenous (IV) antibiotics; however, data assessing this off-label usage are limited. The purpose of this study was to evaluate the real-world efficacy, safety, and financial impact of off-label dalbavancin use. (2) Methods: This is a retrospective, observational study conducted within a 4-hospital health system. Adult patients who received dalbavancin from January 2018 to January 2021 for an off-label indication were included. The primary outcome was clinical success at 90 days. Secondary outcomes included safety (nephrotoxicity and hepatotoxicity). A pharmacoeconomic analysis was performed by comparing the cost of dalbavancin to the anticipated cost of patient stay if standard IV therapy was given. (3) Results: Forty-eight patients met study criteria. Indications included osteomyelitis (54%), endocarditis (23%), bacteremia (15%), and prosthetic joint infection (8%). The predominant organism was S. aureus (60%), with 42% caused by methicillin-resistant S. aureus. Overall, 41 (85%) patients achieved clinical success at 90 days, including 85% with osteomyelitis, 82% with endocarditis, and 86% with bacteremia. There were no instances of nephrotoxicity or hepatotoxicity. Estimated cost avoidance per patient was USD 5313 and USD 1683 if traditional IV therapy would have been completed in the hospital and skilled nursing facility, respectively. (4) Conclusion: Dalbavancin was associated with a relatively high success rate for the treatment of off-label indications and may be a cost-effective alternative to traditional IV antibiotic therapy.

A case report of Nocardia spp. infective endocarditis in an injection drug user.

BACKGROUND: Nocardia-related endocarditis is rare. Intravenous drug use with nonsterile injection practices is a potential risk factor for nocardia infection. Disseminated nocardiosis with endovascular involvement is rarely reported in immunocompetent individuals. CASE PRESENTATION: A 54-year-old male was diagnosed with infective endocarditis due to Nocardia asteroides with septic emboli in the brain and spleen. The use of a matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) rapid diagnostic system was beneficial in identifying the causative organism. He was empirically treated with combination therapy consisting of three antibiotics. Antimicrobial susceptibility testing indicated that all three antibiotics had favorable minimum inhibitory concentrations (MICs). Due to his clinical status, he was not a surgical candidate. Patient passed away after discharge to hospice. CONCLUSIONS: This case demonstrates unique challenges in the identification, diagnosis, and management of Nocardia-related infective endocarditis. A detailed history of injection practices should guide clinicians in assessing the risk for environmental pathogens. Valvular surgery and combination antibiotic therapy should be recommended for all eligible patients to improve the chances of survival.

Considerations for Intravenous Antibiotic Treatment of Prosthetic Joint Infections.

Intravenous antibiotic therapy remains necessary for many patients with prosthetic joint infections. Intravenous therapies may be used for short durations before switching to oral regimens or may be used for the entirety of therapy. Factors to consider intravenous antibiotic selection include pathogen factors such as resistance profiles, host factors such as allergies, and drug factors including how difficult the selected agent would be to administer in the outpatient setting. Monitoring of prolonged intravenous therapy in the outpatient setting requires weekly monitoring of labs with specific labs required to monitor certain antibiotics. This narrative review assesses the appropriate duration, antimicrobial selection by pathogen, and monitoring parameters for intravenous antibiotic treatment of prosthetic joint infections. (Journal of Surgical Orthopaedic Advances 30(4):243-248, 2021).

The Use and Monitoring of Oral Antibiotics for Treatment of Prosthetic Joint Infections.

Intravenous antibiotic therapy remains necessary for many patients with prosthetic joint infections. Intravenous therapies may be used for short durations before switching to oral regimens or may be used for the entirety of therapy. Factors to consider in intravenous antibiotic selection include pathogen factors such as resistance profiles, host factors such as allergies, and drug factors including how difficult the selected agent would be to administer in the outpatient setting. Monitoring of prolonged intravenous therapy in the outpatient setting requires weekly monitoring of labs with specific labs required to monitor certain antibiotics. This narrative review assesses the appropriate duration, antimicrobial selection by pathogen, and monitoring parameters for intravenous antibiotic treatment of prosthetic joint infections. (Journal of Surgical Orthopaedic Advances 30(4):256-262, 2021).

Neisseria gonorrhoeae Septic Arthritis With Contiguous Infection Consistent With Acute Osteomyelitis.

Neisseria gonorrhoeae osteomyelitis is a rare complication of disseminated gonococcal infection. As the rates of N. gonorrhoeae continue to increase in the United States, clinicians may encounter patients with disseminated gonococcal infection complicated by gonococcal osteomyelitis. Screening and appropriate treatment of N. gonorrhoeae remains paramount, especially with growing antibiotic resistance.