Long-term Dalbavancin for Suppression of Gram-Positive Chronic Left Ventricular Assist Device Infections

• Type of Material: Article
• Authors: Sarah Rowe, Emory University; Sarah B. Green, Emory University; Benjamin Albrecht, Emory University; Stephanie Marie Pouch, Emory University
• Language: English
• Date: 2023-11
• Publisher: Oxford University Press
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): https://doi.org/10.1093%2Fofid%2Fofad537
• Title of Journal or Parent Work: Open Forum Infectious Diseases
• Volume: 10
• Issue: 11
• Start Page: ofad537
• Keywords: MRSA; gram-positive; suppression; left ventricular assist device; dalbavancin
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Background Infection is the leading cause of morbidity and mortality in patients with left ventricular assist devices (LVADs). Prolonged suppressive therapy should be strongly considered and is often used in patients with recurrent infections when source control cannot be achieved. Dalbavancin is a promising option in patients with LVADs requiring prolonged durations of antibiotic therapy, especially when no oral alternatives are available. Methods This case series included 8 patients receiving dalbavancin for the long-term suppression of gram-positive infections at Emory University Hospital and Emory St Joseph's Hospital. Results The overall incidence of breakthrough infections occurred in 5 of the 8 patients included in the study. One patient experienced an early breakthrough infection within 1 month of dalbavancin initiation. Another experienced a breakthrough infection within 3 and 6 months of dalbavancin initiation, and the final 3 patients experienced a breakthrough infection within 6 and 12 months. The average duration of dalbavancin suppression therapy among all patients was 229 days, and no adverse effects were reported. Conclusions Dalbavancin is a promising option in patients who require long-term suppression for chronic gram-positive LVAD infections, given its unique pharmacokinetic profile and excellent tissue penetration. The use of biweekly dalbavancin infusions in our 8 patients prevented infection for an extended period of time despite some of the patients not being able to consistently receive infusions. Larger studies are needed to determine the efficacy and safety of using dalbavancin for long-term suppression of gram-positive LVAD infections.