2026 Eastern States Conference

Authors: Sebastian Smreczak PharmD, Mark Adams PharmD, BCPS, Laura Truhlar PharmD, BCCCP

Learning Objective: Audience members will be able to describe the use of dalbavancin for endocarditis and osteomyelitis

Background/Objective: Assess the impact of dalbavancin protocol use for decreasing hospital stay in patients on long term IV antibiotics for osteomyelitis or endocarditis.

Methods: Data for this retrospective cohort study was collected from July 1st, 2024 to April 30th, 2026.  Patients included were 18 years and older with a diagnosis of osteomyelitis or endocarditis who received initial IV antimicrobials at Elliot Hospital. Patients were excluded if they were pregnant or incarcerated. Education was disseminated to providers and pharmacists on dalbavancin protocol treatment. The primary outcome is the number of hospital days decreased using dalbavancin protocol compared to standard therapy. Secondary outcomes include frequency of the type of identified bacteria, number of patients completing outpatient therapy, number of patients lost to follow up, rate of readmission for osteomyelitis or endocarditis, patient disposition, and mortality.

Results: A total of 161 patients were randomly reviewed for the control group with 61 excluded. There were 4 patients included in the dalbavancin analysis with 2 additional having non-study indications and 1 not meeting eligibility. Patient demographics were similar between groups with only statistically significant increases in endocarditis cases and history of IV drug use or AMA in the dalbavancin group. The dalbavancin analysis was not associated with a decrease in inpatient length of stay or increase in outpatient antibiotic days compared to control. A total of 60 hospital days were avoided with the use of dalbavancin. There was no statistical difference in 30 day hospital readmission, outpatient plan compliance, or all-cause mortality.

Conclusions: Due to limited sample size and short duration, a meaningful change in hospital stay for patients on long term IV antibiotics for osteomyelitis or endocarditis was not identified. A total of 60 hospital days were avoided across four patients who received dalbavancin demonstrating potential for a meaningful impact. Further data needs to be collected for appropriate statistical analysis.

Assessment Question: Which of the following is a potential advantage of using dalbavancin for osteomyelitis and endocarditis?
● It requires daily inpatient infusions
● It facilitates outpatient treatment
● It prolongs overall duration of therapy