Hospital Universitario de Móstoles

<h3>Background and Importance</h3> Dalbavancin is approved for the treatment of acute bacterial skin and skin structure infections (ABSSSI). However, its prolonged half-life and activity against Gram-positive pathogens have led to growing off-label use in complex infections. There is limited real-world data describing such use, particularly in secondary-level hospitals. Understanding these practices may support optimised antimicrobial stewardship and resource use. <h3>Aim and Objectives</h3> The primary objective was to describe off-label indications for dalbavancin and identify isolated microorganisms in patients treated at a secondary-level hospital. The secondary objective was to analyse patient characteristics and assess correlations between clinical variables and infection persistence or 90-day mortality. <h3>Material and Methods</h3> A retrospective, observational study was conducted including all patients who received dalbavancin between January 2017 and January 2025. Data were collected on demographics, clinical indication, prescribing department, microbiological findings, and treatment modality. Off-label use was defined as any indication other than ABSSSI. A stepwise backward selection linear regression model was used to evaluate associations with infection persistence or 90-day mortality. Analyses were performed using STATA 17. <h3>Results</h3> Thirty-seven patients were included; 97.3% (n=36) received dalbavancin off-label. The most frequent indications were prosthetic joint infection (29.7%), endocarditis and bacteraemia (16.2% each), spondylodiscitis (13.5%), and osteomyelitis (10.8%). Ambulatory consolidation therapy was used in 83.8% (n=31) following inpatient stabilisation. Gram-positive cocci were most frequently isolated: MRSA (24.3%), <i>S. epidermidis</i> (18.9%), <i>E. faecalis</i> (13.5%), MSSA (8.1%), and <i>E. faecium</i> (5.4%). Polymicrobial infections occurred in 24.3%. In regression analysis, only age remained in the final model (p=0.075), suggesting a trend toward persistent infection in older patients. The overall model was significant (p=0.0293). <h3>Conclusion and Relevance</h3> Dalbavancin was predominantly used off-label, especially for osteoarticular and prosthetic infections. Its pharmacokinetics enabled outpatient management of severe infections, supporting continuity of care and hospital resource optimisation. Age showed a non-significant trend toward infection persistence. Despite a limited sample size, these findings highlight dalbavancin’s utility in complex infections and reinforce the role of hospital pharmacists in promoting its rational, personalised use. <h3>References and/or Acknowledgements</h3> The authors wish to acknowledge the invaluable collaboration of the Hospital Pharmacy Department and the participating clinical services, whose support in data collection and patient management was instrumental to the completion of this study. <h3>Conflict of Interest</h3> No conflict of interest

Abstract Background: Serrated polyposis syndrome, the most prevalent colonic polyposis, confers an increased colorectal cancer risk. Guidelines recommend close colonoscopy surveillance, but recent data suggest low neoplasia rates, supporting longer colonoscopy intervals. Aims: Compare advanced neoplasia incidence between two- and three-year surveillance. Methods: A multicentre, randomized noninferiority trial was performed (May 2021–November 2024) in six Spanish hospitals. Patients meeting 2019 serrated polyposis syndrome WHO criteria I or II, with no advanced polyps and &lt;5 relevant polyps at their previous colonoscopy, were randomized to surveillance at two or three years. The primary endpoint was advanced neoplasia incidence. Results: A total of 131 patients with serrated polyposis syndrome were included (47.3% women; mean age 66.1). Seventy-two were assigned to 2-year and 59 to 3-year colonoscopy. Among 771 resected lesions, 2.4% were advanced adenomas or advanced serrated polyps; no colorectal cancer was detected. The proportion of patients with advanced neoplasia in the surveillance colonoscopy was 6.9% (2-year) vs 13.6% (3-year), with no statistical difference (p=0.208) but with a risk difference of +6.7% (95% CI: –4.1% to 17.5%) exceeding the pre-specified non-inferiority margin of +10%. Time since serrated polyposis syndrome diagnosis &lt;3 years was associated with advanced neoplasia (OR: 4.4; 95% CI: 1.52-14.75; p=0.024). Conclusions: In patients with serrated polyposis syndrome, extending colonoscopy surveillance intervals to three years was not shown to be non-inferior to a two-year interval for advanced neoplasia incidence. The early years of follow-up after serrated polyposis syndrome diagnosis was identified as a risk factor for advanced neoplasia. Clinical trial registry : ClinicalTrials.gov (NCT04906343). Date: 5-10-2021.

The intravascular administration of iodinated contrast agents (IC) can be associated with rare neurological complications such as contrast-induced encephalopathy (CIE). CIE has been primarily reported following cardiac and cerebrovascular angiographic procedures and after endovascular treatment of aneurysms. A 61-year-old woman with a history of breast cancer and recurrent respiratory infections presented with respiratory symptoms and persistent fever despite outpatient antibiotic therapy. A thoracic AngioCT with Iomeprol ruled out pulmonary thromboembolism, suggesting an infection. A few hours later, the patient developed acute confusion, behavioral changes, incoherent speech, and an erythematous rash on the trunk and proximal limbs. She was admitted to exclude ischemic, hemorrhagic, and infectious causes. A non-contrast cranial CT and lumbar puncture showed no significant findings. Other tests, including blood work, venous blood gas, and SARS-CoV-2 PCR, were normal. The patient improved spontaneously within 48 hours. A subsequent cerebral MRI with gadolinium showed no abnormalities. Given the likely association with contrast administration, the patient was referred to our Allergy Clinic. An allergological evaluation was performed, including patch and skin prick tests with Iohexol, Iodixanol, Iobitridol, Iomeprol, and Ioversol. All tests returned negative results at the 48- and 96-hour readings. The patient was discharged with a recommendation to avoid IC, except in very exceptional circumstances. CIE is a very rare, acute, and generally transient complication following the administration of IC. We highlight the importance of being aware of this adverse effect of IC, as it can lead to consultations with allergists.