Clindamycin Plus Vancomycin Versus Linezolid for Treatment of Necrotizing Soft Tissue Infection

Area of Science:

• Infectious Diseases
• Pharmacology
• Critical Care Medicine

Background:

• Necrotizing soft tissue infections (NSTIs) are severe, life-threatening bacterial infections requiring prompt empiric antibiotic therapy.
• Choosing the optimal empiric antibiotic regimen is crucial for improving patient outcomes and minimizing treatment-related toxicities.
• Current guidelines recommend broad-spectrum coverage including agents active against Gram-positives, Gram-negatives, and anaerobes.

Purpose of the Study:

• To compare the safety and efficacy of clindamycin plus vancomycin versus linezolid as empiric treatment for NSTIs.
• To evaluate 30-day mortality, acute kidney injury (AKI), and Clostridioides difficile infection (CDI) rates between the two treatment groups.

Main Methods:

• A retrospective, single-center, quasi-experimental study design.
• Inclusion of patients with NSTI receiving surgical management and either clindamycin or linezolid.
• Matched pair analysis of 62 patients comparing outcomes between treatment groups.

Main Results:

• No significant difference in 30-day mortality between clindamycin/vancomycin and linezolid groups (8.06% vs. 6.45%, P = .65).
• Higher incidence of AKI in the clindamycin/vancomycin group compared to the linezolid group (9.68% vs. 1.61%, P = .05).
• A composite outcome of death, AKI, or CDI was more frequent in the clindamycin/vancomycin group.

Conclusions:

• Clindamycin plus vancomycin demonstrated comparable 30-day mortality to linezolid for empiric NSTI treatment.
• The combination of clindamycin and vancomycin was associated with a higher risk of AKI and a composite adverse outcome.
• Further prospective studies are warranted to confirm these findings and guide optimal empiric therapy selection for NSTIs.