Clinical Pathway With Single-Dose Long-Acting Intravenous Antibiotic Reduces Emergency Department Hospitalizations of Patients With Skin Infections

Acad Emerg Med. 2021 Mar 29. doi: 10.1111/acem.14258. Online ahead of print.


OBJECTIVES: Emergency department (ED) patients with serious skin and soft tissue infections (SSTI) 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 pre- vs. post-intervention design trial at 11 US 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 48-72-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 area was 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% 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.

PMID:33780567 | DOI:10.1111/acem.14258