Children are commonly affected by skin and soft tissue infections (SSTIs); however, data is limited on clindamycin as a preferred treatment and whether resistance testing is impactful. This study was done to determine whether empiric clindamycin use leads to a curative clinical outcome with respect to adverse effects and correlating D-Test resistance.
This retrospective chart review evaluated pediatric patients >18 years of age, who received clindamycin for a SSTI from January - July 2017. The following patient characteristics were collected: patient demographics (age, weight, admitting diagnosis, and past medical history), type of SSTI, need for incision and drainage, antimicrobial(s) administered, antimicrobial sensitivity profile, culture results, and D-Test results. The primary outcomes of the study were days to symptom resolution and overall length of stay (LOS) in the hospital. The secondary outcome was adverse effects of clindamycin and D-Test results.
A total of 32 patients met the inclusion criteria with a mean age 6.9 ± 5.9 years. Twenty four (75.0%) patients had cellulitis, seven (21.9%) had abscesses and one (3.1%) patient had both. Thirteen (40.6%) patients had methicillin-resistant Staphylococcus aureus (MRSA) isolated, while four (12.5%) had methicillin-sensitive Staphylococcus aureus (MSSA) isolated. The overall mean time to symptom resolution occurred at 1.7 ± 0.7 days with an average LOS of 2.3 ± 0.7 days. Four (12.5%) patients were clindamycin resistant and twelve (37.5%) were erythromycin resistant. Seventeen patients (53.1%) had a D-Test done prior to clindamycin use and of those, five (15.6%) were D-Test positive. The mean time to symptom resolution (1.4 ± 0.9 vs. 1.7 ± 0.7 days) and LOS (2.2 ± 0.6 vs. 1.8 ± 0.8 days) were similar for D-Test positive and negative patients, respectively. In addition, one (3.1%) patient had documented diarrhea, but there were no reports of C. difficile. No patients were readmitted for SSTIs during the study time frame.
Conclusion: In our study, clindamycin was effective in treating SSTIs with or without a positive D-Test result. More studies are warranted to further evaluate D-Test results and their correlation to clinical cure and infection recurrence.
A. Siu, None
S. B. Chaudhry, None