Hamada Shoichiro, Nakajima Mikio, Kaszynski Richard H, Kumazawa Ryosuke, Matui Hiroki, Fushimi Kiyohide, Goto Hideaki, Yamaguchi Yoshihiro, Yasunaga Hideo
Emergency and Critical Care Center Tokyo Metropolitan Hiroo Hospital Tokyo Japan.
Department of Trauma and Critical Care medicine School of Medicine Kyorin University Tokyo Japan.
Acute Med Surg. 2021 Feb 19;8(1):e634. doi: 10.1002/ams2.634. eCollection 2021 Jan-Dec.
Combination treatment with clindamycin is recommended in patients with invasive group A infection; however, whether the same treatment is effective in invasive group B and subspecies infections remains unknown. We aimed to investigate whether clindamycin added to standard of care therapy would be effective in patients with invasive non-group A β-hemolytic infections.
This was a nationwide retrospective cohort study using the Japanese Diagnosis Procedure Combination inpatient database focusing on the period between 2010 and 2018. We extracted data on patients diagnosed with sepsis due to non-group A β-hemolytic . One-to-four propensity score-matching was undertaken to compare patients who were treated with clindamycin within 2 days of admission (clindamycin group) and those who did not (control group). The primary outcome was in-hospital mortality.
We identified 3754 eligible patients during the study period. The patients were divided into the clindamycin ( = 296) and control groups ( = 3458). After one-to-four propensity score matching, we compared 289 and 1156 patients with and without clindamycin, respectively. In-hospital mortality did not significantly differ between the two groups (9.7% versus 10.3%; risk difference 0.3%; 95% confidence interval, -3.5% to 4.2%).
This nationwide database study showed that combination therapy involving the use of clindamycin was not associated with lower in-hospital mortality in patients with invasive non-group A β-hemolytic .
对于侵袭性A组感染患者，建议采用克林霉素联合治疗；然而，同样的治疗方法对侵袭性B组及亚种感染是否有效仍不清楚。我们旨在调查在标准治疗方案中加用克林霉素对侵袭性非A组β溶血性感染患者是否有效。
这是一项全国性回顾性队列研究，使用日本诊断流程组合住院患者数据库，研究时间为2010年至2018年。我们提取了因非A组β溶血性感染而被诊断为脓毒症的患者的数据。采用1:4倾向评分匹配法，比较入院后2天内接受克林霉素治疗的患者（克林霉素组）和未接受治疗的患者（对照组）。主要结局指标是住院死亡率。
在研究期间，我们确定了3754例符合条件的患者。这些患者被分为克林霉素组（n = 296）和对照组（n = 3458）。经过1:4倾向评分匹配后，我们分别比较了289例接受克林霉素治疗的患者和1156例未接受治疗的患者。两组的住院死亡率无显著差异（9.7%对10.3%；风险差异0.3%；95%置信区间为-3.5%至4.2%）。
这项全国性数据库研究表明，对于侵袭性非A组β溶血性感染患者，使用克林霉素的联合治疗与较低的住院死亡率无关。
