Evaluation of dalbavancin on length of stay in acute bacterial skin and skin structure infections

Abstract

Purpose Acute bacterial skin and skin structure infections (ABSSSI) are common reasons for hospital admission. A pathway to shift care to the outpatient setting sooner could decrease length of stay (LOS). Our not‐for‐profit community health system has developed a novel practice of partnering with hospitalists as part of a multidisciplinary early discharge of hospitalized patients with dalbavancin for ABSSSI. The primary purpose of this study was to evaluate outcomes associated with this process. Methods This was a retrospective evaluation of an ongoing, prospective process between March 2016 and March 2017. The process involves the hospitalist or infectious diseases pharmacist evaluating patients as possible candidates for dalbavancin therapy. Patients were included if their infection was consistent with cellulitis, abscess, or post‐operative wound infection and they received dalbavancin immediately after discharge from the hospital. The primary outcome was hospital LOS with secondary outcomes of direct cost per case and 30‐day readmission rate. Hospital LOS and 30‐day readmission rate were benchmarked to national averages and internal data from the same time frame the year prior. Results Forty four patients were identified who had received dalbavancin during the time period and met criteria for study inclusion. For the primary outcome of hospital LOS, patients discharged to receive dalbavancin had a mean LOS of 4.3 days similar to published national average (4.95 days in 2011) and lower than internal data (8 days). For secondary outcomes, mean total direct cost per case was $2989 and five patients (11.4%) were readmitted within 30 days similar to published national (16%) and internal data (8.6%). Conclusion Patients discharged to receive dalbavancin had a LOS and overall 30‐day readmission rate below published national data for ABSSSI. Further study is needed to evaluate this process as an effective means to shorten LOS in the management of ABSSSI.

Financial Analysis of Dalbavancin for Acute Bacterial Skin and Skin Structure Infections for Self-Pay Patients

“…The increased risk of side effects and lack of alternate treatment options lend to the ID PharmD being able to determine potential dalbavancin candidates and assist with transitions of care [ 27 ]. The impact of the ID PharmD has been shown in the previous study, as they are able to assist with clinical knowledge skills to aid in selecting, counseling, and effectively treating this patient population with dalbavancin [ 10 ].…”

“…An additional study in Germany demonstrated the cost-savings effect of dalbavancin in MRSA ABSSSI by reducing LOS by 6.45 days with a cost savings of $3099.69 (2865 €) [ 16 ]. The previous study at our institution was associated with decreased cost and length of stay [ 10 ]. The impact of vial replacement was shown to mirror previous data of dalbavancin as a cost-effective option in the self-pay population.…”

“…Factors also evaluated for every patient were if the patient was immunocompetent, hemodynamically stable, afebrile, had a normal (baseline) mental status, and willingness to consent to this therapy option. The process involved a multidisciplinary collaborative approach including the physician, ID PharmD, case manager, and infusion center patient assistance coordinator [ 10 ]. Upon discharge, self-pay, consenting patients received dalbavancin at the health system’s on-site, outpatient infusion center and the healthcare team applied for vial replacement to assist with cost of therapy.…”

“…In a previous study conducted at our institution, dalbavancin resulted in decreased LOS and 30-day readmission rate compared to national data for patients with ABSSSI. While this ultimately led to a reduction in cost for the healthcare system, it included different patient socioeconomic statuses [ 10 ]. Dalbavancin, a long-acting lipoglycopeptide, is FDA indicated to treat adult patients with ABSSSI caused by susceptible isolates of the following gram-positive microorganisms: S. aureus (including MRSA), S. pyogenes , Streptococcus agalactiae , and the Streptococcus anginosus group.…”