1028. Dalbavancin Use in Complicated Infections and-associated Cost-Savings

BACKGROUND: Dalbavancin is a lipoglycopeptide antibiotic active against Gram-positive organisms with an extended half-life that allows for weekly dosing. Initially approved for treating skin and soft-tissue infections, use for more complicated infections provides several potential benefits, particularly in the outpatient setting when daily intravenous antibiotics are not practical due to social or financial issues. METHODS: We conducted a retrospective study to describe dalbavancin use at our institution and to estimate resulting cost avoidance. We identified all patients aged 18 years or older who received at least one dose of dalbavancin via medication records, regardless of setting. RESULTS: 46 patients received dalbavancin between April of 2015 and March of 2019. The most commonly treated infections were bone and joint infections (41%), complicated bacteremias (24%), and skin and soft-tissue infections (20%). The most commonly treated organism was Staphylococcus aureus (55%). A variety of dosing regimens were used, 26 patients (57%) received a single dose to complete a treatment course. The majority of doses were administered in an outpatient infusion center (61%) although 28% of doses were administered in the inpatient setting prior to discharge. Reasons for dalbavancin selection included history of intravenous drug use (35%), contraindications to alternative antibiotics (30%), prior history of nonadherence or manipulation of PICC (18%), other social issues preventing PICC (11%), and limited outpatient daily infusion options due to lack of funding (9%). 4 patients (8.7%) were lost to follow-up. 11 (24%) patients were readmitted to the hospital within 30 days, 2 (4%) of these patients were readmitted with a concern related to their infection or an adverse effect of the dalbavancin infusion. Based on a calculation of equivalent dalbavancin therapy days for each patient, 774 hospital days were saved. In total, this is estimated to be $1,885,479 in overall cost avoidance and a mean cost avoidance of $40,988 per patient. CONCLUSION: As data regarding the efficacy of dalbavancin for more complicated infections continue to emerge, it should be considered as a cost-effective alternative therapy when social and financial factors limit treatment options. DISCLOSURES: All authors: No reported disclosures.