288. Expediting Discharge in Acute Bacterial Skin and Skin Structure Infections: A Clinical and Economic Comparison Between Vancomycin and Oritavancin

BACKGROUND: Acute bacterial skin and skin structure infections (ABSSSI) have a high economic burden secondary to prolonged hospitalizations and high rates of recurrent infections. Utilizing oritavancin rather than vancomycin, select inpatients may be discharged earlier in their hospitalization with anticipated decreased infection recurrences and cost avoidance. METHODS: All inpatients administered oritavancin to expedite discharge and/or vancomycin for the treatment of ABSSSI between May 2017 and January 2018 were included in this retrospective evaluation. The primary endpoint was to determine the 30-day ABSSSI recurrence rate between treatment arms. The secondary endpoints were to evaluate financial expenditures associated with utilization of oritavancin when compared with vancomycin, and to assess for potential risk factors associated with poor outcomes. A financial analysis was performed for patients based on their DRG (diagnosis-related group) applying hospital-specific expenditures provided by the finance department. Data were analyzed using Fisher’s exact test, χ(2) test, or t-test as appropriate. RESULTS: A total of 51 patients receiving oritavancin and 50 patients receiving vancomycin were identified as meeting inclusion criteria. Nine of 50 patients (18%) returned for recurrent infections in the vancomycin arm while only 2 of 51 (4%) returned in the oritavancin arm (P = 0.0279). Out of the 11 patients with recurrent infections, 6 were current intravenous drug users (55%), 3 left against medical advice at their initial visit (27%) and 7 had an emergency department visit in the prior 30 days for the same infection (64%). Overall, there were 111.7 hospitalization days avoided in 51 patients receiving oritavancin, resulting in an estimated cost avoidance of $217,206 compared with conventional treatment with vancomycin. CONCLUSION: Utilizing oritavancin to expedite discharge in hospitalized patients appears to be an effective and financially beneficial treatment for ABSSSI. DISCLOSURES: All authors: No reported disclosures.