Erin K McCreary

Background Necrotizing soft tissue infections (NSTIs) are life-threatening infections. The aim of this study is to evaluate the safety of clindamycin plus vancomycin versus linezolid as empiric treatment of NSTI. Methods Retrospective, single-center, quasi-experimental study of patients admitted from June 1, 2018 to June 30, 2019 (pre-intervention) and May 1, 2020 to October 15, 2021 (post-intervention). Patients who received surgical management within 24 hours of NSTI diagnosis and at least one dose of linezolid or clindamycin were included. The primary endpoint was death at 30 days. The secondary outcomes included rates of acute kidney injury (AKI) and Clostridioides difficile infection (CDI). Results 274 patients were identified by admission diagnosis code for NSTI or Fournier’s Gangrene; 164 patients met the inclusion criteria. Sixty-two matched pairs were evaluated. There was no difference in rates of 30-day mortality (8.06% vs. 6.45%, HR 1.67 95%CI (0.32, 10.73), p = 0.65). There was no difference in CDI (6.45% vs. 1.61%, HR Inf 95%CI (0.66, Inf), p = 0.07) but more AKI in the pre-intervention group (9.68% vs. 1.61%, HR 6 95% CI (0.73, 276), p = 0.05). Conclusions In this small, retrospective, single-center, quasi-experimental study, there was no difference in 30-day mortality in patients receiving treatment with clindamycin plus vancomycin versus linezolid in combination with standard gram-negative and anaerobic therapy and surgical debridement for the treatment of NSTI. A composite outcome of death, AKI, or CDI within 30 days was more common in the clindamycin plus vancomycin group.