Use of Clindamycin for Necrotizing Soft Tissue Infection Decreases Amputation Rate

Abstract

Objective:To identify the impact of clindamycin use on mortality and amputation rates in patients with necrotizing fasciitis.Design:Retrospective review.Setting:Level 1 trauma center, single-center study.Patients/Participants:All patients from 2008 to 2019 with a diagnosis of necrotizing fasciitis. One hundred ninety patients were included in statistical analysis.Intervention:Use of clindamycin in the initial antibiotic regimen in the treatment of necrotizing soft tissue infection.Main Outcome Measurements:Amputation and mortality rates.Results:Patients who received clindamycin had 2.92 times reduced odds of having an amputation when compared with their counterparts, even when American Society of Anesthesiologist scores, comorbidities, smoking, drug use, alcohol consumption, race, ethnicity, sex, and age were controlled for and regardless of other antibiotics started (P = 0.015). There was no significant difference in mortality rate between those patients who did and did not receive clindamycin as part of their initial antibiotic regimen (8.3% vs. 11.6%, respectively; P = 0.453).Conclusion:The use of clindamycin in the initial antibiotic regimen for treatment of NSTI was shown to significantly decrease rates of amputation but not mortality.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Severe necrotizing soft tissue infections—Is wound microbiology a prognostic factor for clinical outcome?

“…Hillman Terzian et al were recently able to demonstrate that a short duration of antibiotic agents of only 48 h after source control is as effective as a longer course of treatment 29 . In another study, it has been demonstrated that an initial treatment with clindamycin is able to decrease the amputation rate with an odds ratio of 2.92, although a reduced mortality could not be observed 30 . These results again put the emphasis on the surgical debridement in combination with the correct initial antibiotic regimen.…”

Targeted Therapy of Severe Infections Caused by Staphylococcus aureus in Critically Ill Adult Patients: A Multidisciplinary Proposal of Therapeutic Algorithms Based on Real-World Evidence

“…A recent retrospective cohort study including 190 patients affected by necrotizing soft tissue infections of lower limbs found that clindamycin was associated with 2.92 times reduced odds of having an amputation when compared with their counterparts, including in adjusted analysis ( p = 0.015) [ 83 ]. No significant difference in mortality rate between patients receiving clindamycin as part of their initial antibiotic regimen and those treated with comparators was reported (8.3% vs. 11.6%; p = 0.45) [ 83 ].…”

What’s New in Musculoskeletal Infection

“…Specific organisms from the Enterobacter, Enterococcus, and Pseudomonas genera were found to have the highest frequency in polymicrobial infections 70 . For necrotizing soft-tissue infections, Heath et al found that early administration of clindamycin as part of the antibiotic regimen conferred a substantial limb-salvage benefit after controlling for multiple other factors 71 .…”