Dalbavancin Use in the Emergency Department Setting

Abstract

Background: Although dalbavancin’s (DBV’s) long half-life and one-time dosing strategy confer ideal administration in the ambulatory setting, the optimal role of DBV in the management of acute bacterial skin and skin structure infections (ABSSSIs) remains to be elucidated. Objectives: The primary objective of this study was to compare treatment outcomes of ABSSSI between patients who received DBV in the emergency department (ED) as part of standard care versus patients who received DBV as part of a telehealth program. Methods: This was a retrospective cohort study evaluating patients who received DBV at 3 urban EDs. The primary end point was the incidence of ABSSSI recurrence. Secondary outcomes included need for hospital admission and ED length of stay (LOS; in hours). Results: A total of 65 ABSSSI treatment courses were included; 42 were included in the telehealth criteria (TC) cohort and 23 in the initial criteria (IC) cohort. There were 14% (6/42) infection recurrences in the TC cohort and 22% (5/23) in the IC cohort, with median time to recurrence being 4 and 14 days, respectively. Median ED LOS was significantly shorter in the TC (5 vs 25 hours, P < 0.05). Numerically fewer individuals in the TC cohort required inpatient admission (0 vs n = 2, 9%). Conclusion and Relevance: Our results suggest that patients may be safely administered DBV in an ED setting, with telehealth follow-up. Providing structured patient selection criteria is an effective method of assisting ED providers in selecting appropriate DBV candidates to limit potential recurrences and readmissions.

Efficacy and safety of dalbavancin in the treatment of acute bacterial skin and skin structure infections (ABSSSIs) and other infections in a real-life setting: data from an Italian observational multicentric study (DALBITA study)

“…Dalbavancin is the first long-acting anti-infective approved by FDA, that has been recently investigated with encouraging results for in-and off-label indications [13,14,16,17,22,[24][25][26][27][28][29][30][31][32]; clinical trials on osteomyelitis and complicated BSI are still ongoing (NCT03091439-NCT03426761-NCT03148756-NCT02940730).…”

The role of dalbavancin for Gram positive infections in the COVID-19 era: state of the art and future perspectives

“…Among the patients with IE, six had no clinical or microbiological evidence of active infection within 90 days of the last dalbavancin dose, whereas two had no documented clinical encounters. Lastly, a recent work reports a successful long-term suppressive dalbavancin treatment in a patient with a Staphylococcus epidermidis and Streptococcus mitis infection of aortic valve and tubular ascending aorta bioprosthetic devices who was not considered eligible for valve replacement surgery and who did not tolerate oral antibiotic therapy [37]. In this case, the administration regimen was scheduled according to the serum bactericidal activity (SBA) levels which were performed immediately before each dalbavancin dose.…”

“…The first is the emergency department (ER). As supported by preliminary data, a patient being evaluated in the ER for a moderate-to-severe cutaneous infection could be directly treated with dalbavancin, immediately discharged and followed up either via the outpatient clinic, by the general practitioner or through telehealth programs [36,37]. This option would avoid unnecessary hospitalization, thus reducing assistance costs and minimizing the risk of nosocomial infections.…”

New Antibiotics for the Treatment of Acute Bacterial Skin and Soft Tissue Infections in Pediatrics

“…This benefit is because their pharmacokinetic characteristics allow a one-time dosing regimen, contrary to what is needed when traditional antibiotic alternatives, including vancomycin, are used. The extreme simplification of the therapy makes these drugs very attractive for the treatment of aSSTIs in the ambulatory setting and emergency room, provided that the patients can be carefully followed up at home [ 74 ]. The administration of a single antibiotic dose eliminates prolonged parenteral therapy; reduces resource utilization; improves compliance; and, because it does not need a peripherally inserted central catheter, lowers the risk of vascular complications and infections.…”