Impact of an Antimicrobial Stewardship and Emergency Department Initiated Dalbavancin Guideline for Patients with Acute Bacterial Skin and Soft-Tissue Infections

BACKGROUND: Acute bacterial skin and skin structure infections (ABSSI) are one of the most common reasons for patient hospitalization. These admissions may be solely for receipt of intravenous vancomycin due to concern for resistance to alternative agents or failure of oral therapy, providing a niche for long-acting agents like dalbavancin. The objective of this study was to evaluate patient outcomes following initiation of a dalbavancin guideline for ABSSI in the emergency department (ED). METHODS: This was a single-center, case series study evaluating adult patients with ABSSI from April 2016 to May 2017 who were screened for receipt of dalbavancin. Candidates were identified by a dalbavancin guideline implemented in the ED in April 2016 with hours from 7 am to 7 pm. Patients were assessed for inclusion by an ED pharmacist and physician. If the patient qualified for receipt of dalbavancin, the ED pharmacist contacted the Antimicrobial Stewardship Team (AST) for final approval. The guideline was revised in January 2017 to lessen restrictions. Patients were contacted via phone by an ED pharmacist for follow-up and the interaction documented in the electronic medical record. Patient data were collected using REDCap™. RESULTS: Overall, 22 patients (15 males/7 females) were evaluated for inclusion to receive dalbavancin. The average age of the patients was 38 years old, ranging from 21 to 61 years. Of these 22 patients, 7 received a single dalbavancin dose of 1,500 mg over 30 minutes for ABSSI (cellulitis {n = 5} and shooter’s abscess {n = 2}). The reasons for exclusion were: lack of systemic signs of infection (n = 5), risk of Gram-negative infection (n = 2), outside guideline time period (n = 2), required hospital support (n = 2), immunocompromised (n = 1), severe hepatic disease (n = 1), bacteremia (n = 1), and diabetic foot infection (n = 1). All patients received a follow-up visit (n = 4) or phone call from the ED pharmacist (n = 3). Only 1 patient required a later hospital admission due to further complications. CONCLUSION: A multidisciplinary team approach to treating ABSSI in the ED was highly successful at our academic medical center. Further expansion of guideline hours should enhance the utilization of this guideline. DISCLOSURES: All authors: No reported disclosures.