Hospital Avoidance Strategies for ABSSSI
Skin Infection
About this trial
This is an interventional treatment trial for Skin Infection focused on measuring Acute bacterial skin and skin structure infections, Hospital avoidance, Antibiotic therapy, Dalbavancin, Emergency department
Eligibility Criteria
Inclusion Criteria:
- Adult (age ≥18 years)
Diagnosis of uncomplicated ABSSSI suspected to be due to Gram-positive bacteria by treating ED clinician, with presence of the following:
- Skin lesion size ≥75 cm2 (measured by area of erythema, edema, and/or induration) AND
- Signs of systemic inflammation (at least 1 of the following: WBC >12,000 or <4,000 cells/mm3; ≥10% immature neutrophils on peripheral smear; temperature >38.3˚C or <36˚C; heart rate >90 bpm, respiratory rate >20 bpm). Signs of systemic inflammation not required if the patient is age >70 years, has diabetes mellitus, or has been treated with immunosuppressive or chemotherapy in the past 90 days.
- Clinical determination by treating ED clinician that patient will need hospital admission for the sole purpose of receiving intravenous antibiotics directed only towards Gram-positive bacteria (e.g., vancomycin, cefazolin) to treat uncomplicated ABSSSI
Exclusion Criteria:
- Risk for ABSSSI due to Gram-negative bacteria (neutropenia with absolute neutrophil count <500 cells/µL, HIV or severely immunocompromised, burns, infection after trauma or as a result of an aquatic environment, infection after skin graft)
- Any abscess requiring bedside or operative drainage
- Infection due to a vascular catheter or prosthetic device
- Infection of a diabetic foot ulcer or decubitus ulcer
- Necrotizing soft tissue infection
- Sepsis (quick SOFA score ≥2) or septic shock (requiring vasopressors to maintain mean arterial pressure ≥65 mmHg despite resuscitation with at least 30mL/kg of IV crystalloid within first 3 hours)
- Recent antibiotics in prior 14 days
- Hypersensitivity to glycopeptides (vancomycin, televancin, dalbavancin, oritavancin)
- Severe renal insufficiency (CrCl <30 mL/min)
- Severe hepatic insufficiency (Child-Pugh Class C)
- Pregnant or nursing
Sites / Locations
- Barnes-Jewish Hospital
Arms of the Study
Arm 1
Arm 2
Active Comparator
No Intervention
Alternative treatment strategy
Usual care
Patient will receive a single dose of dalbavancin administered in the BJH ED or ED observation unit for ABSSSI followed by discharge w/ close Infectious Disease outpatient clinic follow-up.
Patients will receive "usual care" (i.e., hospital admission for intravenous antibiotics - typically, vancomycin) - antibiotic and doses to be determined at the discretion of the treating clinician (both in the BJH ED and on the BJH inpatient ward).