Retrospective Effectiveness Study of Dalbavancin and Other Standard of Care of the Same Class in Patients With ABSSSI

Acute bacterial skin and skin structure infections (ABSSSI), formally referred to as complicated skin and soft tissue infections, include infections such as cellulitis/erysipelas, wound infection, and major cutaneous abscess and have a minimum lesion surface area of approximately 75 cm2. The regulatory definitions of major abscess, cellulitis, and wound infection may not align with practice-based criteria. Common bacterial pathogens causing ABSSSI are Streptococcus pyogenes and Staphylococcus aureus including Methicillin-Resistant Staphylococcus Aureus (MRSA). Less common causes include other Streptococcus species, Enterococcus faecalis, or Gram-negative bacteria.

Increasing dramatically in incidence, a challenging medical problem associated with high direct and indirect costs has been highlighted for both the medical system and society.

Over the last decade, there was a witnessed a dramatic increase in the incidence of community acquired skin infections, an increasing proportion of which are a consequence of MRSA, reinforcing the need for new and effective antibacterial therapies in this disease.

In this context, research has been promoted to develop new antibiotics capable to fight MRSA, the most common multi-drug-resistant Gram+ bacterium in Europe, and to overcome the limitations of the most widely used antibiotics, such as vancomycin, teicoplanin, and β- lactams. These new antibiotics (lipoglycopeptides and new oxazolidinones) have innovative characteristics that make them interesting for the specific treatment of ABSSSIs. Dalbavancin is one of these new antibiotics. Dalbavancin is a lipoglycopeptide with activity against Grampositive organisms, including MRSA, through interference with bacterial cell wall formation by preventing cross-linking of peptidoglycans. Dalbavancin has a distinctive pharmacokinetic profile, with a terminal half-life of 14.4 days, which allows for infrequent or even single intravenous dosing.

This new long-acting antibiotic represents a potential opportunity for early discharge. This approach could profoundly modify the management of these infections by reducing or in some cases eliminating hospitalization costs and risks.

• Xydalba (Drug): Drugs were administered i.v.
• vancomycin, teicoplanin or daptomycin (Drug): Drugs were administered i.v.

Primary outcomes

• Time of discharge from any ward of the hospital, [From baseline to discharge, an average of 4 weeks]: Time of discharge is calculated as the time elapsed from the beginning of antibiotic therapy (baseline) until discharge.

Secondary outcomes

• Evaluation of the recorded signs and symptoms [From the hospital admission until 30 days from discharge]: Evaluation of local signs of inflammation.
• Microbiological evaluation [From the hospital admission until 30 days from discharge]: Eradication of the Gram Positive pathogens identified at baseline (MIC assessment)
• Long-term follow-up [90 days from discharge]: Assessment for recurrence of ABSSSI.

Sex: All, ages: 18 Years to any

Inclusion Criteria:

1. Male and female patients ≥ of 18 years old
2. Patients hospitalized for at least 2 days with evidence of primary diagnosis of ABSSSI of International Classification of Diseases (ICD) 9: - 681.XX (cellulitis and abscess of finger and toe) -682.XX (other cellulitis and abscess) - 958.3X (post-traumatic wound infection not elsewhere classified) - 998.5X (postoperative infection not elsewhere classified); and corresponding code for ICD 10; and/or Diagnosis-related group (DRG) 277; 278; 418 (for Italy), for cellulitis/erysipelas, wound infection, major cutaneous abscess.
3. Patients treated with dalbavancin or other SoC of the same or similar class (i.v. lipo and glycopeptides: teicoplanin, vancomycin, daptomycin) according to summary of product characteristics (SmPC).
4. Patients treated with or without other chemotherapy to cover Gram- bacteria or fungals.
5. Patients who gave their consent for personal data processing according to the local regulation.

Exclusion Criteria:

1. Patients with infected wound or ulcer (neoplastic, inflammatory and autoimmune ulcers), animal bite
2. Patients with ulcer not colonized, discolored, odorous, pressure ulcer grade I, II, III, or IV (according to NPUAP classification - Appendix A)
3. Patients with arteriopathies
4. Patients presenting or who have presented in the last 30 days before the hospitalization the following infections:

   * diabetic foot infection (ICD9= 707.15; 249.8)
   * suspected or confirmed osteomyelitis (ICD9= 730.xx)
   * suspected or confirmed septic arthritis (ICD9= 711.00)
   * infective endocarditis (ICD9=421.0)
   * meningitis (ICD9=322.xx)
   * joint infection (ICD9= 711.00)
   * necrotizing fasciitis (ICD9=728.86)
   * gangrene (ICD9=785.4)
   * prosthetic joint infection or prosthetic implant/device infection (ICD9=996.66)
5. Patient with history of neutropenia or in treatment with immunosuppressants in the last six months before the hospitalization