Operationalizing Single-Dose Long-Acting Lipoglycopeptides for Treatment of ABSSSI in a U.S. Community Hospital...

Long-acting lipoglycopeptides (LaLGPs) offer an alternative to standard intravenous (IV) antibiotics for treating acute bacterial skin and skin structure infections (ABSSSIs). In September 2024, Munson Medical Center (Traverse City, MI) implemented an emergency department (ED)-based dalbavancin protocol targeting stable patients with ABSSSI who would otherwise require short-stay hospital admission. This study evaluated the clinical outcomes, operational feasibility, and financial impact of implementing an ED-based LaLGP protocol for ABSSSI management.

This single-center, quasi-experimental pre-post study was conducted at a community hospital ED in the USA. The pre-implementation group included patients admitted for ≤ 72 h with ABSSSI (July 2022-August 2024). The post-implementation group received 1500 mg of dalbavancin in the ED per protocol (September 2024-May 2025). The primary outcome was 30-day hospital admission for recurrent ABSSSI. Secondary outcomes included 30-day ED visits, new antibiotic prescriptions, and 72-h all-cause admission.

Of 215 patients screened, 67 were included (48 pre-implementation, 19 post-implementation). No significant differences were observed in 30-day recurrent ABSSSI hospitalizations (2.1% versus 10.5%; P = 0.192), ED visits (4.2% versus 10.5%; P = 0.317), new antibiotic prescriptions (27.1% versus 10.5%; P = 0.200), or 72-h all-cause admissions (0% versus 5.3%; P = 0.284). A model-based, assumption-dependent financial analysis estimated that the pathway avoided 36 inpatient days over the 8-month post-implementation period, corresponding to an estimated net positive financial margin of approximately $100,000 USD.

An ED-based LaLGP protocol for ABSSSI management was feasible for selected clinically stable patients. Although some outcomes were numerically higher in the post-implementation group, the small sample size and low event rates limited definitive comparisons.