Efficacy and safety of clindamycin-based treatment for bone and joint infections: a cohort study

  • J. Courjon
  • E. Demonchy
  • E. Cua
  • E. Bernard
  • P.-M. Roger
Original Article
  • 113 Downloads

Abstract

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.

Keywords

Bone and joint infections Clindamycin Staphylococcus Streptococcus Efficacy Tolerance 

References

  1. 1.
    Grammatico-Guillon L, Baron S, Gettner S, Lecuyer A-I, Gaborit C, Rosset P et al (2012) Bone and joint infections in hospitalized patients in France, 2008: clinical and economic outcomes. J Hosp Infect 82:40–48. https://doi.org/10.1016/j.jhin.2012.04.025 CrossRefPubMedGoogle Scholar
  2. 2.
    Lew DP, Waldvogel FA (2004) Osteomyelitis. Lancet Lond Engl 364:369–379. https://doi.org/10.1016/S0140-6736(04)16727-5 CrossRefGoogle Scholar
  3. 3.
    Cook GE, Markel DC, Ren W, Webb LX, McKee MD, Schemitsch EH (2015) Infection in orthopaedics. J Orthop Trauma 29(Suppl 12):S19–S23. https://doi.org/10.1097/BOT.0000000000000461 CrossRefPubMedGoogle Scholar
  4. 4.
    Perry A, Lambert P (2011) Propionibacterium acnes: infection beyond the skin. Expert Rev Anti-Infect Ther 9:1149–1156. https://doi.org/10.1586/eri.11.137 CrossRefPubMedGoogle Scholar
  5. 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. 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
  7. 7.
    Stengel D, Bauwens K, Sehouli J, Ekkernkamp A, Porzsolt F (2001) Systematic review and meta-analysis of antibiotic therapy for bone and joint infections. Lancet Infect Dis 1:175–188. https://doi.org/10.1016/S1473-3099(01)00094-9 CrossRefPubMedGoogle Scholar
  8. 8.
    Pulcini C, Couadau T, Bernard E, Lorthat-Jacob A, Bauer T, Cua E et al (2008) Adverse effects of parenteral antimicrobial therapy for chronic bone infections. Eur J Clin Microbiol Infect Dis 27:1227–1232. https://doi.org/10.1007/s10096-008-0570-y CrossRefPubMedGoogle Scholar
  9. 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
  10. 10.
    Danré A, Courjon J, Bernard E, Cua E, Mondain V, Roger P-M (2015) Safety of antibiotics combinations against staphylococcal bone and joint infections. Joint Bone Spine 82:134–135. https://doi.org/10.1016/j.jbspin.2014.03.021 CrossRefPubMedGoogle Scholar
  11. 11.
    Leigh DA (1981) Antibacterial activity and pharmacokinetics of clindamycin. J Antimicrob Chemother 7 Suppl A:3–9CrossRefPubMedGoogle Scholar
  12. 12.
    Summersgill JT, Schupp LG, Raff MJ (1982) Comparative penetration of metronidazole, clindamycin, chloramphenicol, cefoxitin, ticarcillin, and moxalactam into bone. Antimicrob Agents Chemother 21:601–603CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Norden CW, Shinners E, Niederriter K (1986) Clindamycin treatment of experimental chronic osteomyelitis due to Staphylococcus Aureus. J Infect Dis 153:956–959CrossRefPubMedGoogle Scholar
  14. 14.
    El Samad Y, Havet E, Bentayeb H, Olory B, Canarelli B, Lardanchet J-F et al (2008) Treatment of osteoarticular infections with clindamycin in adults. Med Mal Infect 38:465–470. https://doi.org/10.1016/j.medmal.2008.06.030 CrossRefPubMedGoogle Scholar
  15. 15.
    Zeller V, Dzeing-Ella A, Kitzis M-D, Ziza J-M, Mamoudy P, Desplaces N (2010) Continuous clindamycin infusion, an innovative approach to treating bone and joint infections. Antimicrob Agents Chemother 54:88–92. https://doi.org/10.1128/AAC.01081-09 CrossRefPubMedGoogle Scholar
  16. 16.
    Czekaj J, Dinh A, Moldovan A, Vaudaux P, Gras G, Hoffmeyer P et al (2011) Efficacy of a combined oral clindamycin?Rifampicin regimen for therapy of staphylococcal osteoarticular infections. Scand J Infect Dis 43:962–967. https://doi.org/10.3109/00365548.2011.608082 CrossRefPubMedGoogle Scholar
  17. 17.
    Roger P-M, Farhad R, Leroux S, Rancurel S, Licari M, Bellissimo R et al (2008) Computerized management of a medical department, disease-related group management, clinical research and evaluations. Med Mal Infect 38:457–464. https://doi.org/10.1016/j.medmal.2008.06.027 CrossRefPubMedGoogle Scholar
  18. 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. 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
  20. 20.
    Farhad R, Roger P-M, Albert C, Pélligri C, Touati C, Dellamonica P et al (2010) Six weeks antibiotic therapy for all bone infections: results of a cohort study. Eur J Clin Microbiol Infect Dis 29:217–222. https://doi.org/10.1007/s10096-009-0842-1 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.Infectious Diseases DepartmentNice Academic Hospital, Hôpital Archet 1NiceFrance
  2. 2.Université Côte d’AzurNiceFrance

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