2362. Emergency Department Resource Utilization After Implementation of a Dalbavancin Pathway for Skin and Soft-Tissue Infections

BACKGROUND: Dalbavancin has an extended duration of activity allowing for single-dose treatment of skin and soft-tissue infections (SSTI). An SSTI treatment pathway in the University of Maryland Medical Center (UMMC) Emergency Department (ED) was revised in December of 2016 to add dalbavancin for patients with barriers to treatment adherence as a means of admission avoidance. The purpose of this study was to describe ED resource utilization and outcomes in the patients who received dalbavancin. METHODS: Retrospective evaluation of patients who received dalbavancin in the UMMC ED for an SSTI between December 2016 and March 2018. The primary outcome was 7-day ED revisit after dalbavancin administration for SSTI. Secondary outcomes included immediate hospital admission, 7-day ED revisit for non-SSTI indication, and outpatient follow-up visit attendance. RESULTS: Twenty-four patients received dalbavancin during the study period; 75% were persons who inject drugs (PWID), 46% had a history of prior SSTIs, 17% had HIV/AIDS, 13% were obese. The majority of patients, 22/24 (92%), had CREST I classified cellulitis and were not otherwise candidates for admission. Indications for dalbavancin included failure of oral antibiotics (42%), concern for follow-up (33%), and homelessness (25%). In the ED, 11 (46%) patients had imaging, 6 (25%) had bedside incision and drainage, 2 (8%) blood cultures and 5 (21%) wound cultures, of which 2 grew MRSA and 3 streptococci. Seven of the 24 patients (29%) returned to the ED within 7 days of dalbavancin with a chief complaint related to SSTI. Seven (29%) patients attended their scheduled 14-day outpatient follow-up visit. Two patients (8%) were admitted from the ED after dalbavancin administration, and 4 patients (17%) had an ED revisit within 14 days for a non-SSTI-related indication. No patients experienced any adverse events related to dalbavancin administration. CONCLUSION: While the majority of patients did not have a 7-day ED revisit for SSTI after administration of dalbavancin, ED revisits regardless of indication, and loss to follow-up were common. Dalbavancin may facilitate treatment adherence; however, barriers to successful treatment remain problematic, particularly in a large urban center where patients’ socioeconomic considerations limited the benefit. DISCLOSURES: E. Heil, ALK-Abelló: Grant Investigator, Research grant. K. Claeys, Nabriva: Scientific Advisor, Consulting fee. Melinta: Scientific Advisor, Consulting fee.