title: Vancomycin Combined With Clindamycin for the Treatment of Acute Bacterial Skin and Skin-Structure Infections.
abstract: BACKGROUND
  Acute bacterial skin and skin-structure infections (ABSSSIs) are common causes of hospital admissions. These infections are often caused by methicillin-resistant Staphylococcus aureus; therefore, vancomycin remains a commonly used therapy. The purpose of this study was to compare hospital length of stay (LOS) in patients treated with vancomycin monotherapy vs combination therapy with clindamycin for ABSSSIs.
  
  
  METHODS
  This was a retrospective analysis of 269 patients admitted with ABSSSIs to a 941-bed hospital in northern Alabama. Patients who received either vancomycin monotherapy or vancomycin in combination with clindamycin were included. The primary outcome was hospital LOS; secondary outcomes included 90-day readmission rate and the impact of the following on the primary outcome: organisms cultured, presence of abscess, incision and debridement (I&D), failure of a trial of outpatient antibiotics, and presence of diabetes.
  
  
  RESULTS
  Hospital LOS was similar between groups when evaluating all ABSSSIs (3.7 ± 1.5 days vs 4.0 ± 2.0 days, P = .192, combination and monotherapy, respectively). In patients with abscesses, combination therapy was significantly associated with decreased LOS by 18.2% compared with monotherapy (95% confidence interval [CI], 0.818 [.679 to .985]; P = .034). Among the entire population, significantly fewer patients in the combination group were readmitted within 90 days (5.3% vs 15.3%; P = .006; odds ratio [OR], 3.2; 95% CI [1.35 to 7.66]). The 90-day readmission rates were significantly lower among patients with abscesses as well (2.0% vs 24.3%; P = .0001; OR, 14.6; 95% CI [2.98 to 71.37]).
  
  
  CONCLUSIONS
  Combination therapy with vancomycin and clindamycin was associated with decreased hospital LOS for patients with an abscess. The 90-day hospital readmission rates for those with ABSSSIs may be reduced when combination therapy is utilized. A larger, prospective, multicentered study is needed to validate these findings.
authors.affiliation: Auburn University, Harrison School of Pharmacy, Huntsville, Alabama.
authors.forename: Kurt A
authors.initials: KA
authors.lastname: Wargo
authors.affiliation: Auburn University, Harrison School of Pharmacy, Huntsville, Alabama.
authors.forename: Erin K
authors.initials: EK
authors.lastname: McCreary
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: English
mesh_terms: D058186:Acute Kidney Injury; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002981:Clindamycin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016360:Clostridioides difficile; D003967:Diarrhea; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D017192:Skin Diseases, Bacterial / Q000188:drug therapy* / Q000453:epidemiology*; D014640:Vancomycin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D002981:Clindamycin; D014640:Vancomycin
keywords: Eagle effect; abscess; clindamycin; skin; vancomycin