Abstract
BACKGROUND: Dalbavancin, a long-acting lipoglycopeptide, is approved for acute bacterial skin and soft tissue infections (SSTIs). Its single-dose regimen facilitates discharge and reduces need for outpatient parenteral therapy, aiding patients with housing instability, substance use, or psychiatric illness. While trials show non-inferiority to vancomycin, real-world safety and utilization data are limited. We evaluated whether dalbavancin improves healthcare use and safety outcomes versus vancomycin, linezolid, and daptomycin in a large, matched SSTI cohort. [Figure: see text] [Figure: see text] METHODS: Using TriNetX, we performed three retrospective, 1:1 propensity-matched cohort studies comparing dalbavancin to vancomycin (n=1,052), linezolid (n=989), and daptomycin (n=487) in adults with SSTIs. Matching included age, sex, race, comorbidities (e.g., diabetes, end-stage renal disease [ESRD], HIV), substance use and mental illness. We excluded patients with osteomyelitis, bacteremia, or ICU stays within one month of the index date. Outcomes were assessed within 90 days and included hospital/emergency department (ED) visits, infection-related readmissions, acute kidney injury (AKI), drug-induced liver injury (DILI), rhabdomyolysis, and cytopenias. Odds ratios (ORs) were estimated using multivariable logistic regression models. [Figure: see text] RESULTS: Across all matched cohorts, mean age was 54 years, with 52–58% male and 74–84% White. Dalbavancin was associated with significantly lower infection-related 90-day readmission rates compared to vancomycin (29.1% vs. 38.1%; OR 0.66, p< 0.0001), linezolid (30.3% vs. 41.6%; OR 0.62, p< 0.0001), and daptomycin (27.7% vs. 51.7%; OR 0.36, p< 0.0001). Hospitalization or ED visits were also reduced versus vancomycin (27.1% vs. 38.2%; OR 0.60, p< 0.0001). Dalbavancin had significantly lower AKI rates (< 1%) compared to vancomycin (5.3%), daptomycin (8.2%), and linezolid (3.5%; all p< 0.001). DILI and rhabdomyolysis occurred only in comparator groups. No significant cytopenia differences were observed. CONCLUSION: Dalbavancin was associated with reduced 90-day readmissions and nephrotoxicity in real-world SSTI care. Its simplified dosing benefits patients with adherence barriers and supports value-based care models. DISCLOSURES: All Authors: No reported disclosures