Clindamycin affects group A streptococcus virulence factors and improves clinical outcome.

January 6, 2018 at 12:09 pm

J Infect Dis 2017 Jan 15; 215:269.

Federica Andreoni  Claudia Zürcher  Andrea Tarnutzer  Katrin Schilcher  Andrina Neff Nadia Keller  Ewerton Marques Maggio  Claire Poyart  Reto A. Schuepbach Annelies S. Zinkernagel

Abstract

Group A Streptococcus (GAS) has acquired an arsenal of virulence factors, promoting life-threatening invasive infections such as necrotizing fasciitis. Current therapeutic regimens for necrotizing fasciitis include surgical debridement and treatment with cell wall–active antibiotics. Addition of clindamycin (CLI) is recommended, although clinical evidence is lacking. Reflecting the current clinical dilemma, an observational study showed that only 63% of the patients with severe invasive GAS infection received CLI. This work thus aimed to address whether CLI improves necrotizing fasciitis outcome by modulating virulence factors of CLI-susceptible and CLI-resistant GAS in vitro and in vivo. Treatment with CLI reduced extracellular DNase Sda1 and streptolysin O (SLO) activity in vivo, whereas subinhibitory CLI concentrations induced expression and activity of SLO, DNase, and Streptococcus pyogenes cell envelope protease in vitro. Our in vivo results suggest that CLI should be administered as soon as possible to patients with necrotizing fasciitis, while our in vitro studies emphasize that a high dosage of CLI is essential.

FULL TEXT

https://academic.oup.com/jid/article/215/2/269/2742472

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Entry filed under: Antimicrobianos, Bacterias, Bacteriemias, Epidemiología, Metodos diagnosticos, REPORTS, Resistencia bacteriana, Sepsis, Update.

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