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Association between adjunct clindamycin and in-hospital mortality in patients with necrotizing soft tissue infection due to group A Streptococcus: a nationwide cohort study

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Abstract

Necrotizing soft tissue infection (NSTI) due to group A Streptococcus (GAS) is a severe life-threatening microbial infection. The administration of adjunct clindamycin has been recommended in the treatment of NSTIs due to GAS. However, robust evidence regarding the clinical benefits of adjunct clindamycin in NSTI patients remains controversial. We aimed to investigate the association between early administration of adjunct clindamycin and in-hospital mortality in patients with NSTI attributed to GAS. The present study was a nationwide retrospective cohort study, using the Japanese Diagnosis Procedure Combination inpatient database focusing on the period between 2010 and 2018. Data was extracted on patients diagnosed with NSTI due to GAS. We compared patients who were administered clindamycin on the day of admission (clindamycin group) with those who were not (control group). A propensity score overlap weighting method was adopted to adjust the unbalanced backgrounds. The primary endpoint was in-hospital mortality and survival at 90 days after admission. We identified 404 eligible patients during the study period. After adjustment, patients in the clindamycin group were not significantly associated with reduced in-hospital mortality (19.2% vs. 17.5%; odds ratio, 1.11; 95% confidence interval, 0.59–2.09; p = 0.74) or improved survival at 90 days after admission (hazard ratio, 0.92; 95% confidence interval, 0.51–1.68; p = 0.80). In this retrospective study, early adjunct clindamycin does not appear to improve survival. Therefore, the present study questions the benefits of clindamycin as an adjunct to broad spectrum antibiotics in patients with NSTI due to GAS.

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Data availability

The Japanese Diagnosis Procedure Combination inpatient database.

Code availability

Stata/MP15 (Stata Corp, College Station, TX, USA)

Abbreviations

NSTI:

Necrotizing soft tissue infection

GAS:

Group A Streptococcus

ICD-10:

International Classification of Diseases, Tenth Revision

PS:

Propensity score

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Funding

This work was supported by grants from the Ministry of Health, Labour and Welfare, Japan (21AA2007 and 20AA2005) and the Ministry of Education, Culture, Sports, Science, and Technology, Japan (20H03907)

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Authors and Affiliations

  1. Emergency and Critical Care Center, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya-ku, Tokyo, 150-0013, Japan

    Shoichiro Hamada, Mikio Nakajima, Richard H. Kaszynski & Hideaki Goto

  2. Department of Trauma and Critical Care Medicine, School of Medicine, Kyorin University, 6-20-2, Shinkawa, Mitaka-shi, Tokyo, 181-8611, Japan

    Shoichiro Hamada, Mikio Nakajima & Yoshihiro Yamaguchi

  3. Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan

    Mikio Nakajima, Shunichi Otaka, Hiroki Matsui & Hideo Yasunaga

  4. Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan

    Kiyohide Fushimi

Authors
  1. Shoichiro Hamada
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  2. Mikio Nakajima
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  9. Hideo Yasunaga
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Corresponding author

Correspondence to Shoichiro Hamada.

Ethics declarations

Ethics approval

The present study was approved by The University of Tokyo Institutional Review Board (approval number: 3501–1). Because the data are anonymous, the requirement for patient informed consent was waived.

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All authors directly participated in the planning, execution, or analysis of the study.

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The contents of this manuscript have not been copyrighted or published previously and are not under consideration for publication elsewhere. All authors have read and approved the final version submitted.

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The authors declare no competing interests.

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Hamada, S., Nakajima, M., Kaszynski, R.H. et al. Association between adjunct clindamycin and in-hospital mortality in patients with necrotizing soft tissue infection due to group A Streptococcus: a nationwide cohort study. Eur J Clin Microbiol Infect Dis 41, 263–270 (2022). https://doi.org/10.1007/s10096-021-04376-2

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  • DOI: https://doi.org/10.1007/s10096-021-04376-2

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