Usefulness of a hub and spoke TDM-guided expert clinical pharmacological advice program of dalbavancin for optimizing very long-term curative or suppressive treatment of chronic staphylococcal infections.

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Tác giả: Annamaria Cattelan, Erika Chiari, Pier Giorgio Cojutti, Marco Cotrufo, Massimo Crapis, Maria Danzi, Milo Gatti, Maria Mazzitelli, Giacomo Menegotto, Marianna Meschiari, Giustino Parruti, Federico Pea, Marco Ripa, Alessandro Russo, Laura Soavi, Carlo Tascini, Sara Tedeschi, Pierluigi Viale, Lorenzo Zammarchi, Eleonora Zamparini

Ngôn ngữ: eng

Ký hiệu phân loại: 809.008 History and description with respect to kinds of persons

Thông tin xuất bản: United States : Antimicrobial agents and chemotherapy , 2025

Mô tả vật lý:

Bộ sưu tập: NCBI

ID: 676195

 A hub and spoke model for optimizing long-term treatment of chronic staphylococcal infections with dalbavancin based on therapeutic drug monitoring (TDM)-guided expert clinical pharmacological advice (ECPA) was implemented. This multicentric retrospective cohort study included patients receiving dalbavancin monotherapy lasting >
 6 weeks at different spoke hospitals having treatment optimized by means of a TDM-guided ECPA program at a hub hospital. Optimal pharmacokinetic/pharmacodynamic target against staphylococci with an MIC up to 0.125 mg/L was defined as dalbavancin concentrations >
 8.04 mg/L. Patients received dalbavancin therapy for curative (curative group) or suppressive (suppressive group) purposes. Clinical outcome was assessed by means of repeated ambulatory visits. A total of 12 spoke hospitals applied for 414 TDM-based ECPA for 101 patients, of whom 64.4% (65/101) were treated for curative and 35.6% (36/101) were for suppressive purposes. In the curative and suppressive groups, TDM-based ECPA optimized treatment for up to 14 and 28 months, respectively, and ensured median optimal exposure of 95.7% and 100%, respectively. In the curative group, having <
 70% of treatment time with concentrations above the optimal target increased failure risk [odds ratio (OR), 6.71
  confidence interval (CI), 0.97-43.3
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