Pathway with single‐dose long‐acting intravenous antibiotic reduces emergency department hospitalizations of patients with skin infections

• Published in: Academic emergency medicine 2021-10, Vol.28 (10), p.1108-1117
• Main Authors: Talan, David A., Mower, William R., Lovecchio, Frank A., Rothman, Richard E., Steele, Mark T., Keyloun, Katelyn, Gillard, Patrick, Copp, Ronald, Moran, Gregory J., Kuehl, Damon R.
• Format: Article
• Language: English
• Subjects: abscess; Adult; Anti-Bacterial Agents - therapeutic use; antibacterial agents; Antibiotics; cellulitis; critical pathways; dalbavancin; emergency department; Emergency medical care; Emergency Service, Hospital; health resources; hospital; Hospitalization; Humans; Infections; infectious; Original Contribution; Original Contributions; Patient care planning; skin diseases; Skin Diseases, Infectious - drug therapy; Soft Tissue Infections - drug therapy; wound infection
• ISSN: 1069-6563; 1553-2712
• DOI: 10.1111/acem.14258

Objectives Emergency department (ED) patients with serious skin and soft tissue infections (SSTIs) are often hospitalized to receive intravenous (IV) antibiotics. Appropriate patients may avoid admission following a single‐dose, long‐acting IV antibiotic. Methods We conducted a preintervention versus postintervention design trial at 11 U.S. EDs comparing hospitalization rates under usual care to those using a clinical pathway that included a single IV dalbavancin dose. We enrolled adults with cellulitis, abscess, or wound infection with an infected area of ≥75 cm2 without other indications for hospitalization. Clinical pathway participants discharged from the ED received a 24‐hour follow‐up telephone call and had a 48‐ to 72‐hour in‐person visit. We hypothesized that, compared to usual care, the clinical pathway would result in a significant reduction in the initial hospitalization rate. Results Of 156 and 153 participants in usual care and clinical pathway periods, median infection areas were 255.0 (interquartile range [IQR] = 150.0 to 500.0) cm2 and 289.0 (IQR = 161.3 to 555.0) cm2, respectively. During their initial care, 60 (38.5%) usual care participants were hospitalized and 27 (17.6%) pathway participants were hospitalized (difference = 20.8 percentage points [PP], 95% confidence interval [CI] = 10.4 to 31.2 PP). Over 44 days, 70 (44.9%) usual care and 44 (28.8%) pathway participants were hospitalized (difference = 16.1 PP, 95% CI = 4.9 to 27.4 PP). Conclusions Implementation of an ED SSTI clinical pathway for patient selection and follow‐up that included use of a single‐dose, long‐acting IV antibiotic was associated with a significant reduction in hospitalization rate for stable patients with moderately severe infections. Registration: NCT02961764.