| アブストラクト | 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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| 投稿者 | Hamada, Shoichiro; Nakajima, Mikio; Kaszynski, Richard H; Otaka, Shunichi; Goto, Hideaki; Matsui, Hiroki; Fushimi, Kiyohide; Yamaguchi, Yoshihiro; Yasunaga, Hideo |
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| 組織名 | Emergency and Critical Care Center, Tokyo Metropolitan Hiroo Hospital, 2-34-10,;Ebisu, Shibuya-ku, Tokyo, 150-0013, Japan. s-hmd@umin.ac.jp.;Department of Trauma and Critical Care Medicine, School of Medicine, Kyorin;University, 6-20-2, Shinkawa, Mitaka-shi, Tokyo, 181-8611, Japan.;s-hmd@umin.ac.jp.;Ebisu, Shibuya-ku, Tokyo, 150-0013, Japan.;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.;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. |
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