Vancomycin combined with clindamycin for the treatment of acute bacterial skin and skin-structure infections.
Clin Infect Dis. 2015 Jun 16;
Authors: Wargo KA, McCreary EK, English TM
Abstract
BACKGROUND: Acute bacterial skin and skin-structure infections (ABSSSI) are common causes of hospital admissions. These infections are often caused by methicillin-resistant S. aureus (MRSA), therefore vancomycin remains a commonly used therapy. The purpose of this study was to compare hospital length of stay (LOS) in patients treated with vancomycin monotherapy versus combination therapy with clindamycin for ABSSSI.
METHODS: This was a retrospective analysis of 269 patients admitted with ABSSSI to a 941-bed hospital in North Alabama, USA. Patients who received either vancomycin monotherapy or in combination with clindamycin were included. The primary outcome was hospital LOS, while secondary outcomes included 90-day readmission rate and the impact of the following on the primary outcome: organisms cultured, presence of abscess, incision and debridement (I&D), failure of a trial of outpatient antibiotics, and presence of diabetes.
RESULTS: Hospital LOS was similar between groups when evaluating all ABSSSI (3.7±1.5 vs. 4.0±2.0 days, p=0.192, combination and monotherapy, respectively). In patients with abscesses, combination therapy was significantly associated with decreased LOS by 18.2% compared to monotherapy (95% CI, 0.818 [0.679 - 0.985]; p=0.034). Among the entire population, significantly less patients in the combination group were readmitted within 90 days (5.3% vs. 15.3%, p=0.006; OR 3.2, 95% CI [1.35 - 7.66]). 90-day readmission rates were significantly less among patients with abscesses as well (2.0% vs. 24.3%, p=0.0001; OR 14.6, 95% CI [2.98 - 71.37]).
CONCLUSIONS: Combination therapy with vancomycin and clindamycin was associated with decreased hospital LOS for patients with an abscess. The 90-day hospital readmission rates for ABSSSI may be reduced when combination therapy is utilized. A larger, prospective, multi-centered study is needed to validate these findings.
PMID: 26082508 [PubMed - as supplied by publisher]