Off-Label Use of Dalbavancin in Enterococcus spp. Abscess and Streptococcus pneumoniae Bacteremia Secondary to Septic Arthritis: A Retrospective Case Report
Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsI would like to thank the authors for reporting this case. Few comments to be addressed:
Line 121 The ID physician recommended dalbavancin 1500 mg IV every two weeks 121 for a total duration of six weeks. Do you mean a total of 3 doses?
Is there any rational for this specific dosing? Why not 2 doses, 1 week apart which was studied before in phase 2 RCT for osteomyelitis?
Was strept bacteremia cleared before starting dalbavancin?
Although the manuscript is well written and very concise, it should include some previous evidence to support their decision. Example Veve et al (https://pubmed.ncbi.nlm.nih.gov/33223119/) who included some patients with septic arthritis and enterococcus species as well as a recent meta-analysis (https://pubmed.ncbi.nlm.nih.gov/39029624/).
Author Response
Comment: Line 121 The ID physician recommended dalbavancin 1500 mg IV every two weeks 121 for a total duration of six weeks. Do you mean a total of 3 doses?
Response: Thank you for your comment. Yes, the patient received a total of 3 doses at discharge, each given every 2 weeks.
Comment: Is there any rational for this specific dosing? Why not 2 doses, 1 week apart which was studied before in phase 2 RCT for osteomyelitis?
Response: The physicians decided to give dalbavancin every 2 weeks to improve patient compliance, reduce costs of using additional IV lines, and save nurses time.
Comment: Was strept bacteremia cleared before starting dalbavancin?
Response: Thank you for the clarifying question. Yes, S. pneumonia was cleared from the blood prior to initiating dalbavancin. This was added to the case report for clarity as well.
Comment: Although the manuscript is well written and very concise, it should include some previous evidence to support their decision. Example Veve et al (https://pubmed.ncbi.nlm.nih.gov/33223119/) who included some patients with septic arthritis and enterococcus species as well as a recent meta-analysis (https://pubmed.ncbi.nlm.nih.gov/39029624/).
Response: Thank you for your feedback. These studies have been added to the paper for additional support to strengthen the paper.
Reviewer 2 Report
Comments and Suggestions for AuthorsThe paper describes a case report regarding successful use of dalbavancin in a morbidly obese patient with septic arthritis associated with bacteraemia. The case is very well discussed and presented. The authors have discussed in detail all the relevant findings, parameters and steps of interventions and management. No specific comments from my side.
However, some modifications may be deemed necessary in view of high similarity index.
Comments on the Quality of English LanguageModerate editing in English language required.
Author Response
Comment:
The paper describes a case report regarding successful use of dalbavancin in a morbidly obese patient with septic arthritis associated with bacteraemia. The case is very well discussed and presented. The authors have discussed in detail all the relevant findings, parameters and steps of interventions and management. No specific comments from my side.
However, some modifications may be deemed necessary in view of high similarity index.
Response: Thank you so much for your time to review our paper. We really appreciate it.
Reviewer 3 Report
Comments and Suggestions for AuthorsThe authors have reported a case of septic arthritis successfully treated with Dalbavancin. Overall, the case report seems novel and interesting to the journal reader. However, the Dalbavancin was given only at discharge, making it unclear whether the treatment was successful due to it or if other antibiotics were given earlier. Also, the following corrections/clarifications are necessary before publication:
1. The authors have reported the title as a retrospective case report. However, the case presentation was done prospectively. Kindly clarify why the case report is considered retrospective. If not retrospective, then write a case report.
2. Kindly confirm whether the patient's weight is 145 kg or a typo error.
3. The unit of WBC count, write 21,000 cells instead of 21 K.
4. The treatment in Figure 1 and the description of the treatment in the case do not match each other. Also, in the figure, it is visible that the dalbavancin was given at discharge. It is recommended that the case be described as shown in Figure 1, or the figure should be changed as described in the case presentation.
5. The drug Dalbavancin was given only at discharge; however, other antibiotics were given in the hospital for a long duration, making it unclear whether the treatment was successful due to it or other antibiotics given earlier. The same should be discussed in the limitation section.
6. The conclusion was poorly written. It is recommended that learning points be written in the conclusion.
Author Response
Comment 1. The authors have reported the title as a retrospective case report. However, the case presentation was done prospectively. Kindly clarify why the case report is considered retrospective. If not retrospective, then write a case report.
Response 1: The case report is a retrospective study as it has been conducted a couple of years ago and a year of follow up has since been completed. We have added this timeline to the paper, and we hope it now clarifies that this is a retrospective report.
Comment 2. Kindly confirm whether the patient's weight is 145 kg or a typo error.
Response 2: That is correct. The patient weighs 145kg.
Comment 3. The unit of WBC count, write 21,000 cells instead of 21 K.
Response 3: Thank you so much for the feedback, we have changed the WBC count to 21,000 cells instead of 21k.
Comment 4: . The treatment in Figure 1 and the description of the treatment in the case do not match each other. Also, in the figure, it is visible that the dalbavancin was given at discharge. It is recommended that the case be described as shown in Figure 1, or the figure should be changed as described in the case presentation.
Response: We agree. We added extra verbiage to clarify in the case report that dalbavancin was given only at discharge.
Comment 5: The drug Dalbavancin was given only at discharge; however, other antibiotics were given in the hospital for a long duration, making it unclear whether the treatment was successful due to it or other antibiotics given earlier. The same should be discussed in the limitation section.
Response 5: We also agree with this statement. We have added a limitations section in our paper discussing this issue.
Comment 6. The conclusion was poorly written. It is recommended that learning points be written in the conclusion.
Response 6 : Thank you for the feedback. We have expanded the conclusion to discuss what our learning points are with this case report.
