{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T09:06:17Z","timestamp":1784192777016,"version":"3.55.0"},"reference-count":21,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Background: Long-acting lipoglycopeptides (LALs), including dalbavancin and oritavancin, may facilitate outpatient-oriented management of Gram-positive infections by reducing the need for prolonged hospitalization and daily intravenous therapy. However, real-world evidence on their use in day hospital pathways, particularly for complex off-label infections, remains limited. This study evaluated the clinical effectiveness, safety, and economic impact of LAL-based day hospital management, comparing in-label acute bacterial skin and skin-structure infections (ABSSSI) with complex off-label indications. Methods: This retrospective, multicenter observational study included 160 adult patients treated with dalbavancin and\/or oritavancin in a day hospital setting across nine Italian centers between January 2020 and December 2025. Indications were classified as in-label ABSSSI or off-label infections, including osteomyelitis, prosthetic joint infection, spondylodiscitis, endocarditis, septic arthritis, and prosthetic cardiac infection. The primary endpoint was clinical success at final follow-up. Secondary endpoints included adverse drug events, readmissions, inflammatory marker response, and a budget impact cost-offset analysis based on avoided inpatient bed-days. Results: Overall, 54.4% of patients received LALs for off-label indications, mainly osteomyelitis, prosthetic joint infection, and spondylodiscitis. Clinical outcome was available for 159 patients, with an overall success rate of 86.8% (138\/159). Success rates were 90.4% for in-label ABSSSI and 83.7% for off-label indications, with no statistically significant difference between groups (p = 0.247). In exploratory analyses, monotherapy was associated with lower failure odds; this most likely reflects confounding by indication and should not be interpreted as a treatment effect. Inflammatory markers significantly decreased from baseline to end of therapy. Adverse drug events were uncommon (3.3%), mild, and did not lead to treatment discontinuation. In a scenario-based cost-offset model (no matched inpatient comparator), the strategy corresponded to 1107\u20132214 avoided inpatient bed-days; estimated net savings ranged from approximate cost-neutrality under conservative assumptions (\u20ac11,976) to \u20ac676,176 under maximum assumptions, and one-way sensitivity analysis showed a possible net loss at low inpatient daily-cost values\u2014underscoring that these are modeled rather than observed savings. Conclusions: In this uncontrolled, retrospective cohort, LAL-based day hospital management was feasible and associated with favorable observed clinical outcomes, an acceptable safety profile, and a potential for cost offset in selected patients with Gram-positive infections, including complex off-label indications. Because no matched inpatient or conventional OPAT comparator was included, these findings should be regarded as hypothesis-generating and cannot establish comparative efficacy, superiority, or actual cost savings.<\/jats:p>","DOI":"10.3390\/pathogens15070740","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T03:06:52Z","timestamp":1784084812000},"page":"740","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Saving Beds and Budgets: Real-World Efficacy, Safety, and Pharmacoeconomics of Long-Acting Lipoglycopeptides (LALs) in a Day Hospital Setting"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5650-6911","authenticated-orcid":false,"given":"Andrea","family":"Marino","sequence":"first","affiliation":[{"name":"Infectious Diseases Unit, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Hospital, University of Catania, 91122 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8273-5382","authenticated-orcid":false,"given":"Emmanuele","family":"Venanzi Rullo","sequence":"additional","affiliation":[{"name":"Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3408-4877","authenticated-orcid":false,"given":"Giuseppe","family":"Pipitone","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, ARNAS Civico-Di Cristina, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro Giorgio","family":"Geremia","sequence":"additional","affiliation":[{"name":"Unit of Infectious Diseases, \u201cG. Rodolico-S. Marco\u201d University Hospital, University of Catania, 95121 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8265-5400","authenticated-orcid":false,"given":"Andrea","family":"De Vito","sequence":"additional","affiliation":[{"name":"Unit of Infectious Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0057-3487","authenticated-orcid":false,"given":"Antonio","family":"Albanese","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, Ospedale Papardo, 98124 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7988-5419","authenticated-orcid":false,"given":"Nicholas","family":"Geremia","sequence":"additional","affiliation":[{"name":"Unit of Infectious Diseases, Department of Clinical Medicine, Ospedale \u201cdell\u2019Angelo\u201d, 30174 Venice, Italy"},{"name":"Unit of Infectious Diseases, Department of Clinical Medicine, Ospedale Civile \u201cS.S. Giovanni e Paolo\u201d, 30174 Venice, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9168-3246","authenticated-orcid":false,"given":"Alessandro","family":"Franz\u00f2","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Hospital, University of Catania, 91122 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Cosentino","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Hospital, University of Catania, 91122 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Italia","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Hospital, University of Catania, 91122 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8245-9219","authenticated-orcid":false,"given":"Maria Elena","family":"Ciuppa","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, ARNAS Civico-Di Cristina, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Buzzi","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Hospital, University of Catania, 91122 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Santoro","sequence":"additional","affiliation":[{"name":"Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Iaria","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, ARNAS Civico-Di Cristina, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6099-2273","authenticated-orcid":false,"given":"Giordano","family":"Madeddu","sequence":"additional","affiliation":[{"name":"Unit of Infectious Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmelo","family":"Iacobello","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, Ospedale Papardo, 98124 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa","family":"Manuele","sequence":"additional","affiliation":[{"name":"Unit of Infectious Diseases, \u201cG. Rodolico-S. Marco\u201d University Hospital, University of Catania, 95121 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabrizio","family":"Pulvirenti","sequence":"additional","affiliation":[{"name":"Unit of Infectious Diseases, PO Vittorio Emanuele, ASP Caltanissetta, 93012 Gela, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Cacopardo","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Hospital, University of Catania, 91122 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8113-8452","authenticated-orcid":false,"given":"Giuseppe","family":"Nunnari","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Hospital, University of Catania, 91122 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Munting, A., Damas, J., Arensdorff, L., Cavassini, M., and de Valli\u00e8re, S. (2024). Prolonged Outpatient Parenteral Antimicrobial Treatment: Frequency and Evolution over a Six-Year Period in a Swiss University Hospital. BMC Infect. Dis., 24.","DOI":"10.1186\/s12879-024-10170-0"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1017\/ice.2024.14","article-title":"Length of Antibiotic Therapy among Adults Hospitalized with Uncomplicated Community-Acquired Pneumonia, 2013\u20132020","volume":"45","author":"McCarthy","year":"2024","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Ciusa, G., Pipitone, G., Mancuso, A., Agrenzano, S., Imburgia, C., Geraci, A.M., D\u2019Alcamo, A., Moscarelli, L., Cascio, A., and Iaria, C. (2025). One-Shot, One Opportunity: Retrospective Observational Study on Long-Acting Antibiotics for SSTIs in the Emergency Room\u2014A Real-Life Experience. Pathogens, 14.","DOI":"10.3390\/pathogens14080781"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Ciusa, G., Pipitone, G., Catania, B., Coniglione, G., Imburgia, C., Marsala, M.G.L., Scordo, P., Albanese, A., Cascio, A., and Guaraldi, G. (2025). Preserving Health Beyond Infection Control: Frailty, Weight, and Cognition in OPAT Patients. Antibiotics, 14.","DOI":"10.3390\/antibiotics14111173"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Kalma, B., and van Zundert, A. (2025). Perils of the PICC: Peripherally Inserted Central Catheter-Associated Complications and Recommendations for Prevention in Clinical Practice-A Narrative Review. Healthcare, 13.","DOI":"10.3390\/healthcare13161993"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e70147","DOI":"10.1002\/clc.70147","article-title":"Safety and Efficacy of Outpatient Parenteral Antibiotic Therapy (OPAT) in Patients With Infective Endocarditis: A Systematic Review and Meta-Analysis","volume":"48","author":"Ashraf","year":"2025","journal-title":"Clin. Cardiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"107263","DOI":"10.1016\/j.ijantimicag.2024.107263","article-title":"Safety and Efficacy of Outpatient Parenteral Antimicrobial Therapy: A Systematic Review and Meta-Analysis of Randomized Clinical Trials","volume":"64","author":"Mohammed","year":"2024","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"3349","DOI":"10.2147\/DDDT.S313756","article-title":"Real-World Use of Dalbavancin in the Era of Empowerment of Outpatient Antimicrobial Treatment: A Careful Appraisal Beyond Approved Indications Focusing on Unmet Clinical Needs","volume":"15","author":"Gatti","year":"2021","journal-title":"Drug Des. Dev. Ther."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1007\/s40801-020-00194-8","article-title":"Real-World Use of Oritavancin for the Treatment of Osteomyelitis","volume":"7","author":"Scoble","year":"2020","journal-title":"Drugs Real World Outcomes"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Petropoulou, C., Ioannou, P., Eleftherakis, G., Papazisi, S., Davoulos, C., Drosou, E., Spiliopoulou, A., Tsiata, E., Paliogianni, F., and Kofteridis, D. (2025). Dalbavancin for Bone and Joint Infections: A Two-Center Greek Real-World Retrospective Study. Pathogens, 14.","DOI":"10.3390\/pathogens14111109"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1199","DOI":"10.1080\/23744235.2025.2541853","article-title":"Five-Year Real-World Experience with off-Label Dalbavancin Treatment for Complex Gram-Positive Infections at a Swedish Tertiary Hospital","volume":"57","author":"Hall","year":"2025","journal-title":"Infect. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2405","DOI":"10.1093\/jac\/dkz162","article-title":"On- and off-Label Utilization of Dalbavancin and Oritavancin for Gram-Positive Infections","volume":"74","author":"Morrisette","year":"2019","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1016\/j.jgar.2025.05.014","article-title":"Clinical, Microbiological, and Laboratory Predictors of on- and off-Label Dalbavancin Treatment Failure","volume":"43","author":"Mazzitelli","year":"2025","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_14","first-page":"151","article-title":"Cost-Analysis from Real-World REDS Study on Dalbavancin in Inpatient Treatment of Acute Bacterial Skin and Skin Structure Infections","volume":"12","author":"Scortichini","year":"2025","journal-title":"Glob. Reg. Health Technol. Assess."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1371","DOI":"10.1007\/s10198-022-01432-2","article-title":"Cost-Minimisation Analysis of Oritavancin for the Treatment of Acute Bacterial Skin and Skin Structure Infections from a United Kingdom Perspective","volume":"23","author":"Zinzi","year":"2022","journal-title":"Eur. J. Health Econ."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A New Method of Classifying Prognostic Comorbidity in Longitudinal Studies: Development and Validation","volume":"40","author":"Charlson","year":"1987","journal-title":"J. Chronic Dis."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Foglia, E., Ferrario, L., Schettini, F., Pagani, M.B., Dalla Bona, M., and Porazzi, E. (2022). COVID-19 and Hospital Management Costs: The Italian Experience. BMC Health Serv. Res., 22.","DOI":"10.1186\/s12913-022-08365-9"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1093\/cid\/ciy745","article-title":"2018 Infectious Diseases Society of America Clinical Practice Guideline for the Management of Outpatient Parenteral Antimicrobial Therapya","volume":"68","author":"Norris","year":"2019","journal-title":"Clin. Infect. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2701","DOI":"10.1007\/s15010-025-02619-4","article-title":"Practice Guidelines for Outpatient Parenteral Antimicrobial Therapy (OPAT) in Germany","volume":"53","author":"Tometten","year":"2025","journal-title":"Infection"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1007\/s40261-021-01028-3","article-title":"Dalbavancin Efficacy and Impact on Hospital Length-of-Stay and Treatment Costs in Different Gram-Positive Bacterial Infections","volume":"41","author":"Poliseno","year":"2021","journal-title":"Clin. Drug Investig."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1007\/s40261-020-00891-w","article-title":"Budget Impact Analysis of Dalbavancin in the Treatment of Acute Bacterial Skin and Skin Structure Infections in Three European Countries","volume":"40","author":"Marcellusi","year":"2020","journal-title":"Clin. Drug Investig."}],"container-title":["Pathogens"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-0817\/15\/7\/740\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T08:35:22Z","timestamp":1784190922000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-0817\/15\/7\/740"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,14]]},"references-count":21,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["pathogens15070740"],"URL":"https:\/\/doi.org\/10.3390\/pathogens15070740","relation":{},"ISSN":["2076-0817"],"issn-type":[{"value":"2076-0817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,14]]}}}