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Background  Bone and joint infections (BJI) comprise a series of disorders, including septic arthritis, osteomyelitis, and prosthetic joint infections. Dalbavancin (DALBA) is a lipoglycopeptide with a very long half-life that allows the treatment of serious infections with once weekly or biweekly administration. We evaluated the activity of DALBA against pathogens isolated from BJI.    Methods  A total of 798 organisms were collected from 62 US and 28 European (EU) hospitals in 2016-2020, including 503  S. aureus , 140 β-haemolytic streptococci (BHS), 71 coagulase-negative staphylococci (CoNS), 57  Enterococcus  spp. (ESP), 22 viridans group streptococci (VGS), and 5  S. pneumoniae . Bacteria were identified by standard algorithms and MALDI-TOF-MS. Susceptibility testing was performed by the reference broth microdilution method in a central laboratory.Results    S. aureus  (63.0%) was the most common pathogen associated with BJI, followed by BHS (17.5%), CoNS (8.9%), and ESP (7.1%). All  S. aureus  isolates were susceptible (S) to DALBA (MIC 50/90 , 0.03/0.03 mg/L), linezolid (LNZ; MIC 50/90 , 1/2 mg/L), teicoplanin (TEI; MIC 50/90 , ≤0.5/1 mg/L), vancomycin (VAN; MIC 50/90 , 1/1 mg/L), and daptomycin (DAPTO; MIC 50/90 , 0.25/0.0.5 mg/L. DALBA was 8- to 16-fold more potent than DAPTO and 32- to 64-fold more potent than LNZ, VAN, and TEI against  S. aureus . Oxacillin resistance (OXA-R) rates among  S. aureus  (MRSA rates) were 35.5% and 15.4% in the US and EU, respectively. Ceftaroline (CPT) was active against 98.6% of  S. aureus  (MIC 50/90 , 0.25/1 mg/L) and 94.7% of MRSA (MIC 50/90 , 1/1 mg/L) isolates. Doxycycline and levofloxacin were active against 97.0% and 76.5% of  S. aureus , respectively. Among CoNS, (54.9% OXA-R), DALBA (MIC 50/90 , 0.03/0.03 mg/L; highest MIC, 0.12 mg/L) was the most potent agent, followed by DAPTO (MIC 50/90 , 0.25/0.5 mg/L), CPT (MIC 50/90 , 0.25/0.5 mg/L) and LNZ (MIC 50/90 , 0.5/1 mg/L). The highest DALBA MIC value among BHS and VGS was 0.12 mg/L (MIC 90 , 0.03 mg/L for both groups). VAN was active against 82.4% of ESP and DALBA inhibited all VAN-S ESP at ≤0.06 mg/L.Conclusion  DALBA demonstrated potent  in vitro  activity against common gram-positive organisms (GP) causing BJI and appears to be a valuable option to treat BJI/osteomyelitis caused by GP.    Disclosures    Helio S. Sader, MD, PhD, FIDSA ,  AbbVie (formerly Allergan ) (Research Grant or Support) Basilea Pharmaceutica International, Ltd.  (Research Grant or Support) Cipla Therapeutics  (Research Grant or Support) Cipla USA Inc.  (Research Grant or Support) Department of Health and Human Services  (Research Grant or Support, Contract no. HHSO100201600002C) Melinta Therapeutics, LLC  (Research Grant or Support) Nabriva Therapeutics  (Research Grant or Support) Pfizer, Inc.  (Research Grant or Support) Shionogi  (Research Grant or Support) Spero Therapeutics  (Research Grant or Support)  Leonard R. Duncan, PhD ,  AbbVie (formerly Allergan ) (Research Grant or Support) Basilea Pharmaceutica International, Ltd.  (Research Grant or Support) Cipla Therapeutics  (Research Grant or Support) Cipla USA Inc.  (Research Grant or Support) Department of Health and Human Services  (Research Grant or Support, Contract no. HHSO100201600002C) Shionogi  (Research Grant or Support)  Mariana Castanheira, PhD ,  AbbVie (formerly Allergan ) (Research Grant or Support) Bravos Biosciences  (Research Grant or Support) Cidara Therapeutics, Inc.  (Research Grant or Support) Cipla Therapeutics  (Research Grant or Support) Cipla USA Inc.  (Research Grant or Support) GlaxoSmithKline  (Research Grant or Support) Melinta Therapeutics, Inc.  (Research Grant or Support) Melinta Therapeutics, LLC  (Research Grant or Support) Pfizer, Inc.  (Research Grant or Support) Qpex Biopharma  (Research Grant or Support) Shionogi  (Research Grant or Support) Spero Therapeutics  (Research Grant or Support)  Mariana Castanheira, PhD , Affinity Biosensors (Individual(s) Involved: Self): Research Grant or Support; Allergan (Individual(s) Involved: Self): Research Grant or Support; Amicrobe, Inc (Individual(s) Involved: Self): Research Grant or Support; Amplyx Pharma (Individual(s) Involved: Self): Research Grant or Support; Artugen Therapeutics USA, Inc. (Individual(s) Involved: Self): Research Grant or Support; Astellas (Individual(s) Involved: Self): Research Grant or Support; Basilea (Individual(s) Involved: Self): Research Grant or Support; Beth Israel Deaconess Medical Center (Individual(s) Involved: Self): Research Grant or Support; BIDMC (Individual(s) Involved: Self): Research Grant or Support; bioMerieux Inc. (Individual(s) Involved: Self): Research Grant or Support; BioVersys Ag (Individual(s) Involved: Self): Research Grant or Support; Bugworks (Individual(s) Involved: Self): Research Grant or Support; Cidara (Individual(s) Involved: Self): Research Grant or Support; Cipla (Individual(s) Involved: Self): Research Grant or Support; Contrafect (Individual(s) Involved: Self): Research Grant or Support; Cormedix (Individual(s) Involved: Self): Research Grant or Support; Crestone, Inc. (Individual(s) Involved: Self): Research Grant or Support; Curza (Individual(s) Involved: Self): Research Grant or Support; CXC7 (Individual(s) Involved: Self): Research Grant or Support; Entasis (Individual(s) Involved: Self): Research Grant or Support; Fedora Pharmaceutical (Individual(s) Involved: Self): Research Grant or Support; Fimbrion Therapeutics (Individual(s) Involved: Self): Research Grant or Support; Fox Chase (Individual(s) Involved: Self): Research Grant or Support; GlaxoSmithKline (Individual(s) Involved: Self): Research Grant or Support; Guardian Therapeutics (Individual(s) Involved: Self): Research Grant or Support; Hardy Diagnostics (Individual(s) Involved: Self): Research Grant or Support; IHMA (Individual(s) Involved: Self): Research Grant or Support; Janssen Research & Development (Individual(s) Involved: Self): Research Grant or Support; Johnson & Johnson (Individual(s) Involved: Self): Research Grant or Support; Kaleido Biosceinces (Individual(s) Involved: Self): Research Grant or Support; KBP Biosciences (Individual(s) Involved: Self): Research Grant or Support; Luminex (Individual(s) Involved: Self): Research Grant or Support; Matrivax (Individual(s) Involved: Self): Research Grant or Support; Mayo Clinic (Individual(s) Involved: Self): Research Grant or Support; Medpace (Individual(s) Involved: Self): Research Grant or Support; Meiji Seika Pharma Co., Ltd. (Individual(s) Involved: Self): Research Grant or Support; Melinta (Individual(s) Involved: Self): Research Grant or Support; Menarini (Individual(s) Involved: Self): Research Grant or Support; Merck (Individual(s) Involved: Self): Research Grant or Support; Meridian Bioscience Inc. (Individual(s) Involved: Self): Research Grant or Support; Micromyx (Individual(s) Involved: Self): Research Grant or Support; MicuRx (Individual(s) Involved: Self): Research Grant or Support; N8 Medical (Individual(s) Involved: Self): Research Grant or Support; Nabriva (Individual(s) Involved: Self): Research Grant or Support; National Institutes of Health (Individual(s) Involved: Self): Research Grant or Support; National University of Singapore (Individual(s) Involved: Self): Research Grant or Support; North Bristol NHS Trust (Individual(s) Involved: Self): Research Grant or Support; Novome Biotechnologies (Individual(s) Involved: Self): Research Grant or Support; Paratek (Individual(s) Involved: Self): Research Grant or Support; Pfizer (Individual(s) Involved: Self): Research Grant or Support; Prokaryotics Inc. (Individual(s) Involved: Self): Research Grant or Support; QPEX Biopharma (Individual(s) Involved: Self): Research Grant or Support; Rhode Island Hospital (Individual(s) Involved: Self): Research Grant or Support; RIHML (Individual(s) Involved: Self): Research Grant or Support; Roche (Individual(s) Involved: Self): Research Grant or Support; Roivant (Individual(s) Involved: Self): Research Grant or Support; Salvat (Individual(s) Involved: Self): Research Grant or Support; Scynexis (Individual(s) Involved: Self): Research Grant or Support; SeLux Diagnostics (Individual(s) Involved: Self): Research Grant or Support; Shionogi (Individual(s) Involved: Self): Research Grant or Support; Specific Diagnostics (Individual(s) Involved: Self): Research Grant or Support; Spero (Individual(s) Involved: Self): Research Grant or Support; SuperTrans Medical LT (Individual(s) Involved: Self): Research Grant or Support; T2 Biosystems (Individual(s) Involved: Self): Research Grant or Support; The University of Queensland (Individual(s) Involved: Self): Research Grant or Support; Thermo Fisher Scientific (Individual(s) Involved: Self): Research Grant or Support; Tufts Medical Center (Individual(s) Involved: Self): Research Grant or Support; Universite de Sherbrooke (Individual(s) Involved: Self): Research Grant or Support; University of Iowa (Individual(s) Involved: Self): Research Grant or Support; University of Iowa Hospitals and Clinics (Individual(s) Involved: Self): Research Grant or Support; University of Wisconsin (Individual(s) Involved: Self): Research Grant or Support; UNT System College of Pharmacy (Individual(s) Involved: Self): Research Grant or Support; URMC (Individual(s) Involved: Self): Research Grant or Support; UT Southwestern (Individual(s) Involved: Self): Research Grant or Support; VenatoRx (Individual(s) Involved: Self): Research Grant or Support; Viosera Therapeutics (Individual(s) Involved: Self): Research Grant or Support; Wayne State University (Individual(s) Involved: Self): Research Grant or Support  Rodrigo E. Mendes, PhD ,  AbbVie  (Research Grant or Support) AbbVie (formerly Allergan ) (Research Grant or Support) Cipla Therapeutics  (Research Grant or Support) Cipla USA Inc.  (Research Grant or Support) ContraFect Corporation  (Research Grant or Support) GlaxoSmithKline, LLC  (Research Grant or Support) Melinta Therapeutics, Inc.  (Research Grant or Support) Melinta Therapeutics, LLC  (Research Grant or Support) Nabriva Therapeutics  (Research Grant or Support) Pfizer, Inc.  (Research Grant or Support) Shionogi  (Research Grant or Support) Spero Therapeutics  (Research Grant or Support)

open forum infectious diseases

238. Antimicrobial Activity of Dalbavancin against Gram-Positive Bacteria Isolated from Patients with Bone and Joint Infections from the United States (US) and Europe (2016-2020): Results from the International Dalbavancin Evaluation of Activity (IDEA) Program