Antimicrob Agents Chemother. 2020 Nov 17;64(12):e01495-20. doi: 10.1128/AAC.01495-20. Print 2020 Nov 17.
The use of dalbavancin as a catheter lock solution must be addressed in depth before implementation in clinical practice. We assessed whether a heparin-based dalbavancin lock solution could be frozen in single-dose vials for 6 months without affecting its bioactivity against biofilms of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant Staphylococcus epidermidis (MRSE). Over 6 months, we tested the bioactivity of a frozen solution of dalbavancin (≈1 mg/ml) plus heparin (60 IU) in terms of CFU counts and metabolic activity against biofilms of Staphylococcus aureus ATCC 43300 (MRSA) and Staphylococcus epidermidis ATCC 35984 (MRSE). The Anti-Xa assay was also performed to assess whether the anticoagulant activity of heparin was reduced under freezing. Every month, we compared the mean value of each variable with that obtained at baseline (before freezing, month 0) using both clinical criteria (values were within 25% of the baseline value) and statistical criteria (linear mixed models). At the end of the experiment (month 6), neither a clinically nor a statistically significant reduction in the bioactivity of dalbavancin-heparin solution was observed in terms of CFU counts and metabolic activity against biofilm of MRSA. Regarding MRSE, considering the clinical criteria, neither CFU counts nor metabolic activity decreased significantly. However, the reduction was statistically significant for all variables. Anti-Xa values (mean [standard deviation] international units per milliliter) for heparin in combination with dalbavancin were within 25% of the heparin-water value. A heparin-based dalbavancin lock solution can be frozen for up to 6 months with no effect on its bioactivity against MRSA and MRSE biofilms.