Efficacy and safety of clindamycin-based treatment for bone and joint infections: a cohort study
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Clindamycin has high bioavailability together with good diffusion in bone tissue and could represent an alternative antibiotic compound for the treatment of bone and joint infections (BJIs). However, data regarding the efficacy and safety of clindamycin for BJIs are limited. A monocentric cohort study based on our medical dashboard, which prospectively recorded 28 characteristics for all hospitalized patients since July 2005, was performed. BJIs were selected, and then, all mono-microbial BJI managed with clindamycin-based therapy were included. Remission was defined as the absence of clinical and/or microbiological relapse after treatment. The duration of follow-up without relapse was determined retrospectively using computerized medical records. For 10 years, 196 BJIs, of which 80 (41%) were device-associated infections, were treated with clindamycin-based therapy. The bacterial causative agent was Staphylococcus aureus in 130 cases (66%), coagulase-negative staphylococci in 29 cases (15%), streptococci in 31 cases (16%) and other bacteria in 6 cases (3%). When used in combination therapy, clindamycin was mainly paired with fluoroquinolones (31%) or rifampin (27%). The mean duration of clindamycin treatment was 7.4 ± 3.2 weeks (range, 1–24). An AE was recorded for 9 (4.5%) patients. Remission was recorded for 111 (57%) patients, with a mean duration of clinical follow-up of 28 ± 24 months. Treatment failure occurred in 22 (11%) patients, 50 patients (25%) were lost to follow-up, and 8 (4%) required long-term suppressive therapy. Among the assessable patients, clindamycin-based therapy was efficient in 111/133 cases (83%) and thus represents a reliable and safe alternative treatment option.
KeywordsBone and joint infections Clindamycin Staphylococcus Streptococcus Efficacy Tolerance
We would like to thank Marie-Hélène Schiano, Emilie Leroux, Sophie Leroux and Stephanie Caravel for the implementation of the dashboard in our ward.
P-MR and JC performed the scientific literature search; P-MR was responsible for the study design. JC, ED, EC, EB and P-MR collected the data, and all of the authors interpreted the data. JC and P-MR analyzed the data. P-MR created the figures, and all of the authors were involved in the writing of the report.
Compliance with ethical standards
In France, ethical approval is not required for a non-interventional study. The medical dashboard used in the Infectious Diseases Department at Nice University Hospital is authorized by the French National Commission on Informatics and Liberty (registration number 1430722).
A signed consent form is obtained from each patient at our hospital to enable the use of the clinical data recorded during care for medical research.
Availability of data and material
The dataset analyzed during this study is not publicly available due to individual privacy issues, but it is available from the corresponding author on reasonable request.
- 5.La Société de Pathologie Infectieuse de Langue Française (SPILF), Collège des Universitaires de Maladies Infectieuses et Tropicales (CMIT), Groupe de Pathologie Infectieuse Pédiatrique (GPIP), Société Française d’Anesthésie et de Réanimation (SFAR), Société Française de Chirurgie Orthopédique et Traumatologique (SOFCOT), Société Française d’Hygiène Hospitalière (SFHH) et al (2009) Clinical practice recommendations. Osteoarticular infections on materials (prosthesis, implant, osteosynthesis). Med Mal Infect 39:815–863CrossRefGoogle Scholar
- 6.Berbari EF, Kanj SS, Kowalski TJ, Darouiche RO, Widmer AF, Schmitt SK et al (2015) 2015 Infectious Diseases Society of America (IDSA) clinical practice guidelines for the diagnosis and treatment of native vertebral osteomyelitis in adults. Clin Infect Dis 61:e26–e46. https://doi.org/10.1093/cid/civ482 CrossRefPubMedGoogle Scholar
- 9.Courjon J, Pulcini C, Cua E, Risso K, Guillouet F, Bernard E et al (2013) Antibiotics-related adverse events in the infectious diseases Department of a French teaching hospital: a prospective study. Eur J Clin Microbiol Infect Dis 32:1611–1616. https://doi.org/10.1007/s10096-013-1920-y CrossRefPubMedGoogle Scholar
- 18.Bernard A, Kermarrec G, Parize P, Caruba T, Bouvet A, Mainardi J-L et al (2015) Dramatic reduction of clindamycin serum concentration in staphylococcal osteoarticular infection patients treated with the oral clindamycin-rifampicin combination. J Inf Secur 71:200–206. https://doi.org/10.1016/j.jinf.2015.03.013 Google Scholar
- 19.Curis E, Pestre V, Jullien V, Eyrolle L, Archambeau D, Morand P et al (2015) Pharmacokinetic variability of clindamycin and influence of rifampicin on clindamycin concentration in patients with bone and joint infections. Infection 43:473–481. https://doi.org/10.1007/s15010-015-0773-y CrossRefPubMedGoogle Scholar