Clindamycin resistance in Group A streptococcal infections: A single‐centre retrospective cohort study of 186 patients

Salle, Romain; Chosidow, Olivier; Fihman, Vincent; Prost, Nicolas de; Zeghbib, Narimane; Woerther, Paul‐Louis; Hua, Camille

doi:10.1111/jdv.18981

Cited by 3 publications

(1 citation statement)

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“…A recent study, including 445 patients admitted between 2015 and 2018 in a quaternary referral centre in the USA for NSTI, reported clindamycin resistance in 31% of cultured β-haemolytic streptococci, with a relatively greater risk of amputation in resistant than nonresistant strains [41 ▪ ]. However, previous studies reported lower rates of clindamycin resistance, including patients from Scandinavian centres (<1%, n = 1/113, inclusion period: 2013–2017 [42]), Spain (4.3%, n = 81/1893, inclusion period: 2007–2019 [43 ▪ ]), France (3.8%, n = 9/238, inclusion period: 2015–2022 [44 ▪▪ ]) and USA (14.6%, n = 2508/17179, inclusion period: 2006–2017 [45 ▪ ]). Strikingly, the latest study reported increasing prevalence of clindamycin resistance (22.0% in 2017) attributed to the expansion of several emm types [45 ▪ ].…”

Section: Managementmentioning

confidence: 98%

Severe skin infections

Windsor,

Urbina,

de Prost

2023

Current Opinion in Critical Care

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Purpose of review The incidence of necrotizing soft-tissue infections (NSTI) has increased during recent decades. These infections are still associated with high morbidity and mortality, underlining a need for continued education of the medical community. This review will focus on practical approaches to management of NSTI focusing on antibiotic therapies and optimizing the management of group A streptococcus (GAS)-associated NSTIs. Recent findings Antibiotic therapy for NSTI patients faces several challenges as the rapid progression of NSTIs mandates broad-spectrum agents with bactericidal action. Current recommendations support using clindamycin in combination with penicillin in case of GAS-documented NSTIs. Linezolide could be an alternative in case of clindamycin resistance. Summary Reducing the time to diagnosis and first surgical debridement, initiating early broad-spectrum antibiotics and early referral to specialized centres are the key modifiable factors that may impact the prognosis of NSTIs. Causative organisms vary widely according to the topography of the infection, underlying conditions, and geographic location. Approximately one third of NSTIs are monomicrobial, involving mainly GAS or Staphylococcus aureus. Data for antibiotic treatment specifically for necrotizing soft-tissue infections are scarce, with guidelines mainly based on expert consensus.

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