1774. Impact of Dalbavancin as Step-Down or Salvage Therapy on Duration of Hospitalization Among People Who Inject Drugs

Abstract

Background A well-known clinical dilemma complicating the management of infections in people who inject drugs (PWID) is the restriction of outpatient parenteral antimicrobial therapy. As a result, PWID experience prolonged hospitalizations to complete parenteral antimicrobial courses inpatient. This strategy is also associated with increased rates of patient-directed discharge (PDD). Dalbavancin, a long-acting lipoglycopeptide, serves two unique roles in this population: step-down therapy to decrease inpatient length of stay once clinically stable and salvage therapy in the setting of imminent PDD. Methods This retrospective review of PWID from November 2019 through October 2021 identified patients in which on- or off-label dalbavancin could be considered. Day of hypothetical dalbavancin administration was determined when both ≥7 days of therapy and ≥48 hours of clinical stability (non-critical unit, afebrile, resolved leukocytosis, and source control or negative blood cultures) were completed. Included patients had ≥7 days of therapy remaining at time of hypothetical dalbavancin administration. A one-time dalbavancin dose was considered to provide up to 14 days of antimicrobial coverage. Patients were included in either the step-down cohort (completed entire parenteral antimicrobial course inpatient) or salvage therapy cohort (PDD prior to completing course). The number of potentially preventable inpatient days with dalbavancin and readmissions due to infection progression were assessed in each cohort, respectively. Results Nineteen patients were identified as potential dalbavancin candidates. In the step-down cohort (n=11) a one-time dalbavancin dose prevented a maximum of 146 inpatient days. In the salvage cohort (n=8), hypothetical dalbavancin administration at time of PDD could have prevented six readmissions due to infection progression, associated with 36 additional inpatient days. Conclusion Inpatient administration of dalbavancin may bridge treatment disparities experienced by PWID by reducing unnecessary inpatient days for parenteral antibiotic administration and by preventing hospital readmissions attributable to inadequate antimicrobial course. Disclosures All Authors: No reported disclosures.