Increasing clindamycin resistance in group A streptococcus

White, Bryan P.; Siegrist, Emily A

doi:10.1016/s1473-3099(21)00456-4

Cited by 16 publications

(11 citation statements)

References 2 publications

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“…The use of clindamycin for skin and soft tissue infections is generally predicated on its activity against MRSA, as well as its anti-toxin effects, excellent penetration into soft tissues, and efficacy in killing bacteria in the stationary phase of growth [21,22]. Resistance rates of Group A Streptococci to clindamycin vary widely from 4 to 40% [17] and are on the increase [23]; hence, this agent is rarely used as monotherapy without knowledge of local antibiograms. The use of clindamycin alongside an anti-Staphylococcal backbone agent for complex S. aureus infections with associated bacteraemia has been evaluated via a pilot multi-centred randomised controlled trial in adults and children [24] and has been incorporated as a key arm of an ongoing adaptive platform trial (S. aureus Network Adaptive Platform (SNAP) trial) [25].…”

Section: Discussionmentioning

confidence: 99%

Acute bacterial lymphadenitis in children: a retrospective, cross-sectional study

2023

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Acute bacterial lymphadenitis is a common childhood condition, yet there remains considerable variability in antibiotic treatment choice, particularly in settings with low prevalence of methicillin-resistant Staphylococcus aureus such as Europe and Australasia. This retrospective cross-sectional study reviewed children presenting with acute bacterial lymphadenitis to a tertiary paediatric hospital in Australia between 1 October 2018 and 30 September 2020. Treatment approaches were analysed with respect to children with complicated versus uncomplicated disease. A total of 148 children were included in the study, encompassing 25 patients with complicated disease and 123 with uncomplicated lymphadenitis, as defined by the presence or absence of an associated abscess or collection. In culture-positive cases, methicillin-susceptible S. aureus (49%) and Group A Streptococcus (43%) predominated, while methicillin-resistant S. aureus was seen in a minority of cases (6%). Children with complicated disease generally presented later and had a prolonged length of stay, longer durations of antibiotics, and higher frequency of surgical intervention. Beta-lactam therapy (predominantly flucloxacillin or first-generation cephalosporins) formed the mainstay of therapy for uncomplicated disease, while treatment of complicated disease was more variable with higher rates of clindamycin use. Conclusion: Uncomplicated lymphadenitis can be managed with narrow-spectrum beta-lactam therapy (such as flucloxacillin) with low rates of relapse or complications. In complicated disease, early imaging, prompt surgical intervention, and infectious diseases consultation are recommended to guide antibiotic therapy. Prospective randomised trials are needed to guide optimal antibiotic choice and duration in children presenting with acute bacterial lymphadenitis, particularly in association with abscess formation, and to promote uniformity in treatment approaches. What is Known:• Acute bacterial lymphadenitis is a common childhood infection.• Antibiotic prescribing practices are highly variable in bacterial lymphadenitis. What is New:• Uncomplicated bacterial lymphadenitis in children can be managed with single agent narrow-spectrum beta-lactam therapy in low-MRSA prevalence settings.• Further trials are needed to ascertain optimal treatment duration and the role of clindamycin in complicated disease.

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Section: Discussionmentioning

confidence: 99%

Acute bacterial lymphadenitis in children: a retrospective, cross-sectional study

2023

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“…The overuse of clindamycin, vancomycin and gentamicin was associated with a 50% increased risk of an SSI versus cefazolin monotherapy [61]. This may be due clindamycin resistance by both Group A streptococci and S. aureus being near 50% in many regions [62 ▪ ,63]. Clindamycin also has an increased risk of C. difficile infection in this population [62 ▪ ].…”

Section: Surgical Antibiotic Prophylaxismentioning

confidence: 96%

Using antibiotics wisely

Jung,

Cozzi,

Forrest

2023

Current Opinion in Infectious Diseases

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Purpose of review This review will describe role of shorter antibiotic therapies, early switch from intravenous to oral therapy, and artificial intelligence in infectious diseases. Recent findings There is evidence that shorter courses of antibiotics are noninferior to standard durations of therapy. This has been demonstrated with Enterobacterales bacteremia that can be treated with 7 days of therapy, community acquired pneumonia with 3 days and ventilator associated pneumonia with just 7 days of antibiotic therapy. The conversion from intravenous to oral therapy in treating bacteremia, endocarditis and bone and joint infections is safe and effective and reduces line complications and costs. Also, for clean surgical procedures only one dose of antibiotic is needed, but it should be the most effective antibiotic which is cefazolin. This means avoiding clindamycin, removing penicillin allergies where possible for improved outcomes. Finally, the role of artificial intelligence to incorporate into using antibiotics wisely is rapidly emerging but is still in early stages. Summary In using antibiotics wisely, targeting such as durations of therapy and conversion from intravenous antibiotic therapy to oral are low hanging fruit. The future of artificial intelligence could automate a lot of this work and is exciting but needs to be proven. Video abstract http://links.lww.com/COID/A50

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“…The latter typically includes a β-lactam (e.g., piperacillin/tazobactam), while the former includes clindamycin ( 13, 17, 18 ), which at sublethal concentrations in vitro, inhibits expression of several tissue-damaging toxins. However, the use of clindamycin is now threatened by increasing rates of resistance in healthcare settings ( 17–19 ).…”

Section: Introductionmentioning

confidence: 99%

Dihydrothiazolo ring-fused 2-pyridone antimicrobial compounds treatStreptococcus pyogenesskin and soft tissue infection

Zou,

Obernuefemann,

Singh

et al. 2024

Preprint

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We have developed GmPcides from a peptidomimetic dihydrothiazolo ring-fused 2-pyridone scaffold that have antimicrobial activities against a broad-spectrum of Gram-positive pathogens. Here we examine the treatment efficacy of GmPcides using skin and soft tissue infection (SSTI) and biofilm formation models byStreptococcus pyogenes. Screening our compound library for minimal inhibitory (MIC) and minimal bactericidal (MBC) concentrations identified GmPcide PS757 as highly active againstS. pyogenes. Treatment ofS. pyogenesbiofilm with PS757 revealed robust efficacy against all phases of biofilm formation by preventing initial biofilm development, ceasing biofilm maturation and eradicating mature biofilm. In a murine model ofS. pyogenesSSTI, subcutaneous delivery of PS757 resulted in reduced levels of tissue damage, decreased bacterial burdens and accelerated rates of wound-healing, which were associated with down-regulation of key virulence factors, including M protein and the SpeB cysteine protease. These data demonstrate that GmPcides show considerable promise for treatingS. pyogenesinfections.

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Increasing clindamycin resistance in group A streptococcus

Cited by 16 publications

References 2 publications

Acute bacterial lymphadenitis in children: a retrospective, cross-sectional study

Acute bacterial lymphadenitis in children: a retrospective, cross-sectional study

Using antibiotics wisely

Dihydrothiazolo ring-fused 2-pyridone antimicrobial compounds treatStreptococcus pyogenesskin and soft tissue infection

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