Reviewed by Caitlin Crews-Stowe, PhD, MPH, CPH, CPHQ, VA-BC, CIC
This study looked to evaluate the efficacy of dalbavancin vs standard therapy in 200 patients with complicated Staphylococcus aureus bacteremia in 23 medical centers in the U.S. and Canada. Patients with a diagnosis of complicated bacteremia, defined per the 2011 IDSA guidelines, who had achieved blood culture clearance and resolution of fever, that had received at least 72 hours but no more than 10 days of antibiotics were eligible. Eligible participants were randomized to either receive dalbavancin 1500mg IV on days 1 and 8 (n=100), or single agent standard therapy (cefazolin or anti-staphylococcal penicillin for MSSA, vancomycin or daptomycin for MRSA) (n=100). Patients with left-sided endocarditis, CNS infections, retained infected prosthetic material, and severe immune compromise were excluded. The primary outcome evaluated was desirability of outcome ranking (DOOR) at day 70 by 4 infectious disease experts who were masked to treatment assignment. The DOOR ranking examines clinical success, infectious complications, safety complications, mortality, and health-related quality of life. Results showed that in patients who had previously achieved blood culture clearance, dalbavancin was not superior to standard therapy by DOOR (Probability- 47.7%; 95% CI, 39.8%-55.7%), including through all key subgroups (pathogen, site of infection, duration of bacteremia, etc.). This demonstrates that dalbavancin is a treatment option for patients with complicated S. aureus bacteremia following culture clearance.
Reference:
Turner NA, Hamasaki T, Doernberg SB, et al. Dalbavancin for Treatment of Staphylococcus aureus Bacteremia: The DOTS Randomized Clinical Trial. JAMA. 2025;334(10):866–877. doi:10.1001/jama.2025.12543