Use of Dalbavancin in Treatment of Acute Bacterial Skin and Skin Structure Infections: Case Series from a Canadian Perspective.

Introduction: Treatment of acute bacterial skin and skin structure infections (ABSSSIs) with intravenous (IV) antibiotics is difficult in marginalized populations, such as people who inject drugs, due to issues such as unstable housing or mental health conditions. These factors often require extended hospital admissions for IV antibiotics. Dalbavancin, a novel lipoglycopeptide antibiotic effective against gram-positive bacteria, lasts over 14 days and may be suitable for patients who struggle with traditional IV antibiotic administration. Methods: This was a case series in which we reviewed 19 patients referred to our cellulitis clinic in London, Ontario, Canada, between February 1 and July 30, 2023, who received a single dose of IV dalbavancin for ABSSSIs as out-patients. Those who were enrolled had severe infections requiring IV antibiotics, with psychosocial factors pre-cluding out-patient IV therapy, or were at high risk of non-adherence to oral antibiotics. Results: The median age of patients was 43 (range 36-56 years); they were mostly male (74%), unemployed (89%), and with unstable housing (58%). Positive outcomes were observed in 13 out of 19 (68%) patients; 3 out of 19 had indeterminate outcomes (could not be reached for follow-up but were not admitted to any institution within our catchment area) and 3 out of 19 had negative outcomes (needed further antibiotics following dalbavancin). Conclusion: Our experience shows that a single IV dose of dalbavancin is effective in treating ABSSSIs in patients with complex psychosocial factors, as positive outcomes were observed in most patients. Dalbavancin eliminates the need for indwelling IV access and may reduce hospital admissions for patients for whom traditional antibiotic regimens may be challenging.