Consolidation Therapy Shows Promise but Highlights Study Limitations

In this study of dalbavancin for complicated Staphylococcus aureus bloodstream infections, patients were only eligible for randomization once their blood cultures cleared, fevers resolved, and clinical improvement was evident. Investigators emphasized that dalbavancin served as a consolidation therapy, administered at the point where patients would typically transition toward discharge. Outcomes were assessed using the Desirability of Outcome Ranking (DOOR), which captured continued improvement, recurrence, and the need for additional treatments.

While results suggested dalbavancin could reduce reliance on PICC lines and simplify discharge planning, several limitations were noted. Subgroup sizes were small, limiting insights into key populations such as patients with endocarditis or bone and joint infections. Additionally, the DOOR endpoint, though promising, remains a relatively coarse tool with broad categories; more refined outcome measures may be needed to fully capture patient-centered benefits. The findings support dalbavancin as a potential discharge-ready option, but highlight the need for larger trials and more nuanced outcome assessments.