Effectiveness of Clindamycin and Intravenous Immunoglobulin, and Risk of Disease in Contacts, in Invasive Group A Streptococcal Infections

Jonathan Carapetis, Peter Jacoby, K Carville, Seong-Jin Joel Ang, Nigel Curtis, Ross Andrews

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Background: The use of clindamycin and intravenous immunoglobulin (IVIG) in treatment of invasive group A streptococcal (iGAS) infection, and the need for prophylactic antibiotics in close contacts, remains contentious. Controlled trials are unlikely to be conducted, so prospective, observational studies provide the best data to inform practice.

    Methods: We conducted population-based, prospective, active surveillance of iGAS infections throughout the state of Victoria, Australia (population 4.9 million), from March 2002 through August 2004.

    Results: Eighty-four cases of severe iGAS infection (streptococcal toxic shock syndrome, necrotizing fasciitis, septic shock, or GAS cellulitis with shock) were identified. Clindamycin-treated patients had more severe disease than clindamycin-untreated patients but lower mortality (15% vs 39%; odds ratio [OR], 0.28; 95% confidence interval [CI], .10-.80). Among those who received concurrent IVIG, the fatality rate was lower still (7%). The adjusted point estimate of the OR for mortality was lower in clindamycin-treated patients (0.31; 95% CI, .09-1.12) and clindamycin plus IVIG-treated patients (0.12; 95% CI, .01-1.29) compared with clindamycin-untreated patients. Three confirmed cases of iGAS infection occurred in household contacts of index cases. The incidence rate of iGAS disease in contacts was 2011 (95% CI, 413-5929) times higher than the population incidence in Victoria.

    Conclusions: Our data suggest that clindamycin treatment of patients with severe iGAS infections substantially reduces mortality and that this effect may be enhanced by concurrent treatment with IVIG. The dramatically increased risk of iGAS disease among household contacts within 1 month of the index case highlights a potential role for antibiotic prophylaxis.
    Original languageEnglish
    Pages (from-to)358-365
    Number of pages8
    JournalClinical Infectious Diseases
    Volume59
    Issue number3
    DOIs
    Publication statusPublished - 2014

    Fingerprint

    Streptococcal Infections
    Clindamycin
    Intravenous Immunoglobulins
    Confidence Intervals
    Victoria
    Septic Shock
    Mortality
    Odds Ratio
    Population
    Necrotizing Fasciitis
    Cellulitis
    Antibiotic Prophylaxis
    Incidence
    Observational Studies
    Shock
    Therapeutics
    Prospective Studies
    Anti-Bacterial Agents

    Cite this

    Carapetis, Jonathan ; Jacoby, Peter ; Carville, K ; Joel Ang, Seong-Jin ; Curtis, Nigel ; Andrews, Ross. / Effectiveness of Clindamycin and Intravenous Immunoglobulin, and Risk of Disease in Contacts, in Invasive Group A Streptococcal Infections. In: Clinical Infectious Diseases. 2014 ; Vol. 59, No. 3. pp. 358-365.
    @article{c520fbf1284845c8b8b04587ed169777,
    title = "Effectiveness of Clindamycin and Intravenous Immunoglobulin, and Risk of Disease in Contacts, in Invasive Group A Streptococcal Infections",
    abstract = "Background: The use of clindamycin and intravenous immunoglobulin (IVIG) in treatment of invasive group A streptococcal (iGAS) infection, and the need for prophylactic antibiotics in close contacts, remains contentious. Controlled trials are unlikely to be conducted, so prospective, observational studies provide the best data to inform practice. Methods: We conducted population-based, prospective, active surveillance of iGAS infections throughout the state of Victoria, Australia (population 4.9 million), from March 2002 through August 2004. Results: Eighty-four cases of severe iGAS infection (streptococcal toxic shock syndrome, necrotizing fasciitis, septic shock, or GAS cellulitis with shock) were identified. Clindamycin-treated patients had more severe disease than clindamycin-untreated patients but lower mortality (15{\%} vs 39{\%}; odds ratio [OR], 0.28; 95{\%} confidence interval [CI], .10-.80). Among those who received concurrent IVIG, the fatality rate was lower still (7{\%}). The adjusted point estimate of the OR for mortality was lower in clindamycin-treated patients (0.31; 95{\%} CI, .09-1.12) and clindamycin plus IVIG-treated patients (0.12; 95{\%} CI, .01-1.29) compared with clindamycin-untreated patients. Three confirmed cases of iGAS infection occurred in household contacts of index cases. The incidence rate of iGAS disease in contacts was 2011 (95{\%} CI, 413-5929) times higher than the population incidence in Victoria. Conclusions: Our data suggest that clindamycin treatment of patients with severe iGAS infections substantially reduces mortality and that this effect may be enhanced by concurrent treatment with IVIG. The dramatically increased risk of iGAS disease among household contacts within 1 month of the index case highlights a potential role for antibiotic prophylaxis.",
    author = "Jonathan Carapetis and Peter Jacoby and K Carville and {Joel Ang}, Seong-Jin and Nigel Curtis and Ross Andrews",
    year = "2014",
    doi = "10.1093/cid/ciu304",
    language = "English",
    volume = "59",
    pages = "358--365",
    journal = "Clinical Infectious Diseases",
    issn = "1058-4838",
    publisher = "Oxford University Press",
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    Effectiveness of Clindamycin and Intravenous Immunoglobulin, and Risk of Disease in Contacts, in Invasive Group A Streptococcal Infections. / Carapetis, Jonathan; Jacoby, Peter; Carville, K; Joel Ang, Seong-Jin; Curtis, Nigel; Andrews, Ross.

    In: Clinical Infectious Diseases, Vol. 59, No. 3, 2014, p. 358-365.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Effectiveness of Clindamycin and Intravenous Immunoglobulin, and Risk of Disease in Contacts, in Invasive Group A Streptococcal Infections

    AU - Carapetis, Jonathan

    AU - Jacoby, Peter

    AU - Carville, K

    AU - Joel Ang, Seong-Jin

    AU - Curtis, Nigel

    AU - Andrews, Ross

    PY - 2014

    Y1 - 2014

    N2 - Background: The use of clindamycin and intravenous immunoglobulin (IVIG) in treatment of invasive group A streptococcal (iGAS) infection, and the need for prophylactic antibiotics in close contacts, remains contentious. Controlled trials are unlikely to be conducted, so prospective, observational studies provide the best data to inform practice. Methods: We conducted population-based, prospective, active surveillance of iGAS infections throughout the state of Victoria, Australia (population 4.9 million), from March 2002 through August 2004. Results: Eighty-four cases of severe iGAS infection (streptococcal toxic shock syndrome, necrotizing fasciitis, septic shock, or GAS cellulitis with shock) were identified. Clindamycin-treated patients had more severe disease than clindamycin-untreated patients but lower mortality (15% vs 39%; odds ratio [OR], 0.28; 95% confidence interval [CI], .10-.80). Among those who received concurrent IVIG, the fatality rate was lower still (7%). The adjusted point estimate of the OR for mortality was lower in clindamycin-treated patients (0.31; 95% CI, .09-1.12) and clindamycin plus IVIG-treated patients (0.12; 95% CI, .01-1.29) compared with clindamycin-untreated patients. Three confirmed cases of iGAS infection occurred in household contacts of index cases. The incidence rate of iGAS disease in contacts was 2011 (95% CI, 413-5929) times higher than the population incidence in Victoria. Conclusions: Our data suggest that clindamycin treatment of patients with severe iGAS infections substantially reduces mortality and that this effect may be enhanced by concurrent treatment with IVIG. The dramatically increased risk of iGAS disease among household contacts within 1 month of the index case highlights a potential role for antibiotic prophylaxis.

    AB - Background: The use of clindamycin and intravenous immunoglobulin (IVIG) in treatment of invasive group A streptococcal (iGAS) infection, and the need for prophylactic antibiotics in close contacts, remains contentious. Controlled trials are unlikely to be conducted, so prospective, observational studies provide the best data to inform practice. Methods: We conducted population-based, prospective, active surveillance of iGAS infections throughout the state of Victoria, Australia (population 4.9 million), from March 2002 through August 2004. Results: Eighty-four cases of severe iGAS infection (streptococcal toxic shock syndrome, necrotizing fasciitis, septic shock, or GAS cellulitis with shock) were identified. Clindamycin-treated patients had more severe disease than clindamycin-untreated patients but lower mortality (15% vs 39%; odds ratio [OR], 0.28; 95% confidence interval [CI], .10-.80). Among those who received concurrent IVIG, the fatality rate was lower still (7%). The adjusted point estimate of the OR for mortality was lower in clindamycin-treated patients (0.31; 95% CI, .09-1.12) and clindamycin plus IVIG-treated patients (0.12; 95% CI, .01-1.29) compared with clindamycin-untreated patients. Three confirmed cases of iGAS infection occurred in household contacts of index cases. The incidence rate of iGAS disease in contacts was 2011 (95% CI, 413-5929) times higher than the population incidence in Victoria. Conclusions: Our data suggest that clindamycin treatment of patients with severe iGAS infections substantially reduces mortality and that this effect may be enhanced by concurrent treatment with IVIG. The dramatically increased risk of iGAS disease among household contacts within 1 month of the index case highlights a potential role for antibiotic prophylaxis.

    U2 - 10.1093/cid/ciu304

    DO - 10.1093/cid/ciu304

    M3 - Article

    VL - 59

    SP - 358

    EP - 365

    JO - Clinical Infectious Diseases

    JF - Clinical Infectious Diseases

    SN - 1058-4838

    IS - 3

    ER -