Evaluation of clindamycin use in bone and joint infections: is monotherapy a safe option? A monocentric observational study 2014-19

Abstract

Background: Selecting an optimal antibiotic regimen for bone and joint infections (BJIs) is challenging due to limited high-quality evidence. Although clindamycin is widely used as an alternative treatment for susceptible microorganisms in combination therapy, its use as monotherapy is increasing. This study aimed to evaluate the efficacy and safety of clindamycin monotherapy for BJI treatment.

Methods: A monocentric observational study was conducted using data from the Reference Centre for complex BJI at our tertiary university hospital between 2014 and 2019. All adult patients with microbiologically confirmed BJI receiving clindamycin after a multidisciplinary meeting were included. Patients infected with clindamycin non-susceptible strains were excluded. Treatment failure was defined as relapse, treatment change or death from any cause within 1 year. Associations between monotherapy and treatment failure were assessed using multivariate logistic regression and inverse probability of treatment weighting (IPTW) analysis to adjust for the propensity to receive monotherapy.

Results: A total of 137 patients were included, of whom 88 received clindamycin monotherapy. Overall, 41/137 treatment failures were observed (16/88 in the monotherapy group, 25/49 in the combination group). Monotherapy was associated with fewer failures in both multivariate (OR = 0.18; 95% CI, 0.07-0.46; P < 0.001) and IPTW-adjusted models (OR = 0.36; 95% CI, 0.17-0.76; P = 0.008). Patients treated with monotherapy presented with milder infections, less fever and lower Charlson comorbidity scores, with significantly lower baseline C-reactive protein levels (102.6 versus 65.7 mg/L; P = 0.006). Fewer adverse events were reported in the monotherapy group (4/88 versus 8/49, P = 0.04).

Conclusions: Clindamycin monotherapy appears to be a reliable and safe therapeutic option for selected patients with less severe BJI.

Figure 1.

Treatment associated with clindamycin for patients treated in combination regimen. Forty-seven patients were treated with a combination of two antibiotics. Two patients were treated with a combination of three antibiotics: clindamycin/fluoroquinolone/rifampicin and clindamycin/penicillin/rifampicin. BLI, β-lactamase inhibitor.