589 - Use of Dalbavancin in Facilitating Discharge of High Risk Patients in Low Resource Settings

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Presenting Author(s)

Alexander Milgrom

Infectious Diseases Fellow
University of South Carolina School of Medicine
Columbia, South Carolina
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: Background
Patients who inject intravenous drugs (PWID) can have devastating infections with poor outcomes while being burdensome to the healthcare system, both in terms of lack of payment and length of stay. These issues are only exacerbated in settings where addiction treatment resources such as medication assisted therapy (MAT) are limited. One potential method of alleviating some of this burden is with long acting glyco-lipopeptide antibiotics, such as dalbavancin, to reduce length of stay.

Methods: Methods
A retrospective evaluation of 10 PWID patients treated with dalbavancin to facilitate early discharge was performed at Prisma Health Richland hospital in 2019. Reduction in length of stay was calculated based on estimated length of stay typical for treatment of their clinical syndrome.

Results: Results
Average length of stay was reduced by 22.4 days. 9 of the patients were seen inpatient, and one was evaluated outpatient. 4 patients (40%) had documented mental illness in their chart diagnoses, and 7 (70%) of patients were uninsured. 4 (40%) of patients had a history of leaving AMA, 2 (20%) were rehospitalized within 30 days, Of these 10 patients, only 1 patient who already had been following as an outpatient had appropriate follow-up with an Infectious Disease specialist after treatment.

Conclusion: Discussion
Long acting glyco-lipopeptide antibiotics can facilitate discharging patients from an inpatient setting where status as PWID cannot be managed in an outpatient setting. On average, a little over 3 weeks was saved in terms of hospital days, which is a significant savings for the hospital system. However, it remains unclear how much this benefits the patient as follow-up for this treatment was abysmal and thus it is difficult to assess for the clinical response. Further evaluation is required to the utility of such treatments, as well as the implementation of MAT and more widespread assistance for this vulnerable population.