Dalbavancin Reduces Hospital Stay and Improves Productivity for Patients with Acute Bacterial Skin and Skin Structure Infections: The ENHANCE Trial

Matthew W McCarthy, Katelyn R Keyloun, Patrick Gillard, Justin J Choi, Nicholas Pickell, Ronald Copp, Thomas J Walsh, Matthew W McCarthy, Katelyn R Keyloun, Patrick Gillard, Justin J Choi, Nicholas Pickell, Ronald Copp, Thomas J Walsh

Abstract

Introduction: Admissions for acute bacterial skin and skin structure infections (ABSSSI) are often prolonged because of intravenous (IV) antibiotics. Use of a long-acting IV antibiotic may reduce length of stay (LOS) on a hospitalist service. The ENHANCE ABSSSI trial sought to determine the impact on LOS and work productivity in patients treated with a long-acting IV antibiotic, dalbavancin, vs. usual care at an urban tertiary-care center.

Methods: A single-center, pre- vs. post-period pragmatic trial at Weill-Cornell Medical Center assessed usual care for consecutively enrolled admitted ABSSSI patients during an observational period (pre-period). Identification and treatment of eligible admitted ABSSSI patients with dalbavancin were implemented in the post-period. Those with life-threatening infections, requiring multiple antibiotics/intensive care, or with unstable comorbidities were excluded. Outcomes were assessed over a 44-day follow-up period.

Results: Of 48 and 43 patients enrolled, respectively, in the pre- and post-periods, mean infection-related LOS was reduced in the post-period (3.2 days vs. 4.8 days; P = 0.003). Similar results were found in an adjusted LOS analysis. Work productivity and activity impairment outcomes significantly improved in the post-period (P ≤ 0.01). Complete response rates were similar: 50% (pre-period) and 57% (post-period). Among AEs identified, 17% (n = 7) were found to have possible causal relation to dalbavancin in the post-period. Few AEs were serious (n = 3; 7% post-period versus n = 1; 2% pre-period).

Conclusion: After implementing the ENHANCE ABSSSI pathway, LOS was significantly reduced by almost 2 days, with potential improvements in work productivity and ability to complete daily activities.

Trial registration: ClinicalTrials.gov identifier, NCT03233438.

Funding: Allergan plc.

Keywords: Acute bacterial skin and skin structure infection; Cost; Dalbavancin; Long-acting antibiotic.

Figures

Fig. 1
Fig. 1
Patient disposition. *Patient 2010047 provided informed consent for the study, but withdrew it shortly thereafter. Due to timing of consent withdrawal, the patient was removed from the study database. EC3: Known or suspected infections that are severe, life-threatening, or not included in the ABSSSI FDA guidance, including the following examples: gangrene; known or suspected necrotizing fasciitis; known or suspected osteomyelitis, septic arthritis, or endocarditis; diabetic foot infection; and decubitus or ischemic ulcer. EC9: Unwilling or unable to follow study procedures. IC3: Willing and able to return to the hospital or a designated clinic for scheduled visits, or be in contact with the study coordinator through telephone communication, as required by the protocol and the antibiotic treatment administered
Fig. 2
Fig. 2
Histogram of infection-related length of stay. LOS length of stay

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