Pharmacist-Directed Use of Dalbavancin in Acute Bacterial Skin and Skin Structure Infections to Reduce Hospital Length of Stay

Abstract

BackgroundAcute bacterial skin and skin structure infections (ABSSSI) are a rapidly increasing cause of hospitalization. Prolonged length of stay (LOS) increases the cost burden to health systems due to administration of parenteral antimicrobials. Dalbavancin is a lipoglycopeptide providing a full course of therapy with one dose and is indicated for the treatment of patients with ABSSSI and presents a unique opportunity for cost avoidance by decreasing inpatient LOS and shifting care to the outpatient setting. This study evaluated the practice of a pharmacist-directed model for discharging hospitalized patients with ABSSSI to receive intravenous dalbavancin at a hospital outpatient infusion center.MethodsA quasi-experimental investigation of an ongoing, prospective process with open enrollment for patients discharged to receive single-dose dalbavancin therapy between March 2016 and March 2017. To be eligible, adult patients must have been admitted with an ABSSSI based upon inclusion and exclusion via International Classification of Diseases codes. Subjects were compared with a cohort of patients from March 2015 through March 2016 (comparator group) meeting the same criteria for inclusion and exclusion. The primary outcome is hospital LOS and secondary outcomes are cost-savings associated with a reduced LOS and hospital readmission within 30 days of discharge.ResultsFifty-three patients were identified who received dalbavancin during the enrollment period, and 44 were included in the study. In the comparator group 1191 patients were identified of which 945 were included in the study. Hospital LOS (4.3 vs. 8.0, P < 0.001) and total direct cost per case ($7,863 vs. $2,989, P < 0.001) were statistically significantly decreased for the dalbavancin group compared with the comparator group. Readmission rates at 30 days were similar between the dalbavancin and comparator groups (11.4% vs. 8.6%, P = 0.34).ConclusionPatients discharged to an outpatient infusion center to receive dalbavancin had a decreased LOS and total direct cost per case in relation to the comparator group of standard of care. No statistically significant difference in readmission rates was observed. Early goal-directed discharge for the treatment of patients with ABSSSI is a safe and effective way to decrease LOS.Disclosures B. Jones, Allergan: Speaker’s Bureau, Speaker honorarium