Single-Dose Long-acting Lipoglycopeptide Clinical Pathway for Treatment of Cellulitis in the Emergency Department: A How-to Guide Based on Real-World Implementation at a Community Hospital Health System

Document Type

Conference Proceeding

Publication Date

1-11-2026

Publication Title

Open Forum Infect Dis

Keywords

antibiotic agent, dalbavancin, lipoglycopeptide, cellulitis, clinical outcome, clinical pathway, cohort analysis, community hospital, conference abstract, controlled study, cost benefit analysis, cost control, emergency department visit, emergency ward, female, health care system, hospital admission, hospitalization, human, length of stay, major clinical study, male, outpatient department, prescription, retrospective study, single drug dose, therapy

Abstract

Background: Long-acting lipoglycopeptides (LaLGPs) are emerging as promising alternatives for the treatment of cellulitis in patients who might otherwise require short-stay hospitalization. Compared to standard intravenous antibiotic regimens, LaLGPs may offer advantages in both clinical efficiency and healthcare resource utilization. In September 2024, Munson Medical Center (Traverse City, MI) implemented a LaLGP-based clinical pathway in the emergency department (ED) to streamline cellulitis care and reduce hospital admissions. Methods: This single-center retrospective cohort study compared two groups: a pre-implementation cohort (patients hospitalized ≤ 72 hours for cellulitis from July 2022 - August 2024) and a post-implementation cohort (patients receiving ED-administered dalbavancin from September 2024 - April 2025). The primary outcome was 30-day hospital admission for recurrent cellulitis. Secondary outcomes included ED or urgent care visit within 30 days for recurrent cellulitis, antibiotic prescriptions for recurrent cellulitis within 30 days, and all-cause hospital admission within 72 hours. A cost analysis estimated potential savings by calculating avoidable hospital days using publicly available financial data and the average length of stay from the pre-implementation cohort. Results: Of the 208 patients screened, 60 met inclusion criteria: 48 in the preimplementation cohort and 12 in the post-implementation cohort. No statistically significant differences were observed between cohorts in 30-day outcomes for recurrent cellulitis,Including hospital admissions (2.1% vs. 8.3%; p=0.36), ED or urgent care visits (4.2% vs. 8.3%; p=0.50), antibiotic prescriptions (27% vs. 8.3%; p=0.26), or 72-hour all-cause hospital admission (0% vs. 8.3%; p=0.20). Over the 8-month study period, an estimated 22.8 hospital days were avoided in the ED-LaLGP cohort (n=12). Excluding initial ED visit costs, this corresponds to a projected cost savings of $52,919 USD - approximately $4,409 USD per patient. Conclusion: These findings support the use of an ED-LaLGP clinical pathway as a viable strategy to reduce short-stay hospitalizations for cellulitis, offering comparable clinical outcomes with improved cost-efficiency for both patients and healthcare systems.

Volume

13

First Page

S578

Last Page

S579

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