Analysis of Infectious Complications Related to Chronic Suppressive Therapy With Dalbavancin

Background: Dalbavancin, a long-acting lipoglycopeptide antibiotic, is increasingly used off-label as chronic suppressive therapy for infections involving retained prosthetic material. However, data on infectious complications during long-term use remain limited. Material and Methods: This is a retrospective, multicenter cohort study in 4 hospitals in south-eastern Spain, including adult patients treated with dalbavancin for over 12 weeks. Clinical, microbiological, and therapeutic data were collected. The primary endpoint was superinfection-related hospitalization; secondary outcomes included infectious complications, infection resolution, recurrence, and mortality. Patients were stratified by treatment duration (3 to 6, 6 to 12, or >12 mo). Results: Among 274 patients who received dalbavancin, 21 met the inclusion criteria. Most infections were prosthetic joint-related (33.3%), with Staphylococcus epidermidis as the most common pathogen (33.3%). Superinfections occurred in 47.6%, more often with longer treatment (71.4% at 6 to 12 mo; 50% at >12 mo; vs. 16.7% at 3 to 6 mo), with no significant trend and weak correlation with treatment length. They were mainly caused by gram-negative bacteria (38.1%) and were associated with bacteremia and urinary tract infections. Infection resolution after 1-year post-treatment follow-up was achieved in 57.1% of cases, including all patients treated for 3 to 6 months. No treatment discontinuations due to adverse effects were recorded. Conclusions: These findings suggest that dalbavancin is a safe and potentially effective long-term suppressive option for selected patients, especially those with retained prosthetic material and no surgical alternative. Nonetheless, the increased frequency of superinfections in longer treatments warrants further investigation. Prospective studies are needed to confirm these observations and define the benefit-risk balance.