Evidence map›Paper›PMID 34755257›Full record

ArticleEuropean journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology2022

Association between adjunct clindamycin and in-hospital mortality in patients with necrotizing soft tissue infection due to group A Streptococcus: a nationwide cohort study.

Shoichiro Hamada, Mikio Nakajima, Richard H Kaszynski, Shunichi Otaka, Hideaki Goto, Hiroki Matsui, Kiyohide Fushimi, Yoshihiro Yamaguchi, Hideo Yasunaga

Abstract read
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In one paragraph

Article in European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Shoichiro HamadaEmergency and Critical Care Center, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya-ku, Tokyo, 150-0013, Japan. s-hmd@umin.ac.jp.ORCID http://orcid.org/0000-0003-1330-8736
Mikio NakajimaEmergency and Critical Care Center, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya-ku, Tokyo, 150-0013, Japan.
Richard H KaszynskiEmergency and Critical Care Center, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya-ku, Tokyo, 150-0013, Japan.
Shunichi OtakaDepartment of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
Hideaki GotoEmergency and Critical Care Center, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya-ku, Tokyo, 150-0013, Japan.
Hiroki MatsuiDepartment of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
Kiyohide FushimiDepartment of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
Yoshihiro YamaguchiDepartment of Trauma and Critical Care Medicine, School of Medicine, Kyorin University, 6-20-2, Shinkawa, Mitaka-shi, Tokyo, 181-8611, Japan.
Hideo YasunagaDepartment of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.

Funding

Ministry of Education, Culture, Sports, Science and Technology 20H03907Ministry of Health, Labour and Welfare 20AA2005Ministry of Health, Labour and Welfare 21AA2007
6 · The paper itself

Abstract

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.

Indexed as

Hospital MortalityStreptococcus pyogenesAgedAnti-Bacterial AgentsClindamycinCohort StudiesFasciitis, NecrotizingFemaleHospitalizationHumansMaleMiddle AgedProportional Hazards ModelsRetrospective StudiesSoft Tissue InfectionsStreptococcal InfectionsAnti-Bacterial AgentsClindamycinClindamycinGroup A StreptococcusMortalityNecrotizing soft tissue infectionPropensity score

Identifiers

PMID34755257

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.