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

David A. Talan; William R. Mower; Frank A. Lovecchio; Richard E. Rothman; Mark T. Steele; Katelyn Keyloun; Patrick Gillard; Ronald Copp; Gregory J. Moran

doi:10.1111/acem.14258

Back

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

Journal article

Open access

Peer reviewed

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

David A. Talan, William R. Mower, Frank A. Lovecchio, Richard E. Rothman, Mark T. Steele, Katelyn Keyloun, Patrick Gillard, Ronald Copp and Gregory J. Moran

Academic emergency medicine, Vol.28(10), pp.1108-1117

10/2021

DOI: 10.1111/acem.14258

PMCID: PMC8597095

PMID: 33780567

Files and links (1)

url

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8597095View

Published (Version of record) Open Access

Abstract

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.

Details

Title: Subtitle: Pathway with single‐dose long‐acting intravenous antibiotic reduces emergency department hospitalizations of patients with skin infections
Creators: David A. Talan - Ronald Reagan UCLA Medical Center
William R. Mower - Ronald Reagan UCLA Medical Center
Frank A. Lovecchio - Creighton University
Richard E. Rothman - Johns Hopkins University
Mark T. Steele - Truman Medical Center
Katelyn Keyloun - AbbVie (United States)
Patrick Gillard - AbbVie (United States)
Ronald Copp - ICON plc, Dublin, Ireland.
Gregory J. Moran - Olive View-UCLA Medical Center
Contributors: Damon R. Kuehl (Editor)
Resource Type: Journal article
Publication Details: Academic emergency medicine, Vol.28(10), pp.1108-1117
DOI: 10.1111/acem.14258
PMID: 33780567
PMCID: PMC8597095
NLM abbreviation: Acad Emerg Med
ISSN: 1069-6563
eISSN: 1553-2712
Language: English
Date published: 10/2021
Academic Unit: Emergency Medicine; Internal Medicine
Record Identifier: 9984296976402771

Metrics

20 Record Views

13 Times Cited - Web of Science