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

Carapetis, Jonathan R.; Jacoby, Peter; Carville, Keryln; Ang, Seong-Jin Joel; Curtis, Nigel; Andrews, Ross M.

doi:10.1093/cid/ciu304

Cited by 202 publications

(141 citation statements)

References 27 publications

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“…As demonstrated for pharyngitis, their use may limit antibiotic overprescription and focus the treatment, limiting the side effects and the emergence of antimicrobial resistance (5,23). It may also be helpful for optimizing therapy by adding antitoxin antibiotics, such as clindamycin, and intravenous immunoglobulin, which reduce the risk of fatal outcome (24,25).…”

Section: Discussionmentioning

confidence: 99%

Reassessment of the Role of Rapid Antigen Detection Tests in Diagnosis of Invasive Group A Streptococcal Infections

et al. 2016

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i Rapid antigen detection tests (RADTs) for group A streptococci (GAS) are widely used for diagnosing acute pharyngitis, which has led to a considerable reduction in antibiotic prescriptions over the past decade. Beyond this intended use, their reassessment on invasive samples may be relevant in the management of life-threatening GAS infections. To this end, we evaluated the performances of three RADTs, culture, GAS PCR, and 16S rRNA gene PCR assays, and compared them with a composite gold standard (GAS-PCR assay and/or culture) for the diagnosis of severe GAS infection. A total of 192 specimens from deep-tissue (mostly normally sterile) sites enriched for 75 GAS-positive samples were enrolled in the study. The three evaluated RADTs showed sensitivities ranging from 88.0% to 94.7% versus 98.7% for GAS PCR, 84% for 16S rRNA gene PCR, and 77.3% for culture. The sensitivities of the ImmunoCard STAT! Strep A test (Meridian Bioscience) and the NADAL Strep A strip (Nal Von Minden) were similar to that of GAS PCR (P ‫؍‬ 0.25 and 0.03, respectively) and higher than that of culture (P ‫؍‬ 0.001 and 0.006, respectively), whereas the SD Bioline Strep A test strip (Standard Diagnostics) showed a performance similar to that of culture (P ‫؍‬ 0.02). The three RADTs detected 10 distinct emm types, including a predominance of emm 1 (33.3%), emm 89 (10.6%), and emm 12 (7.6%). No false-positive results were observed, leading to a specificity of 100% for all the evaluated RADTs. The GAS RADTs turned out to be sensitive, specific, and easy-to-use tools that may aid in the management of invasive GAS infections in 24/7 point-of-care laboratories by enabling early diagnosis and focused therapy. Group A streptococci (GAS) are common bacterial pathogens responsible for mild diseases, such as pharyngitis, and invasive and life-threatening infections resulting from their dissemination into deep tissues. The worrying increase in the prevalence of these severe infections and their high fatality rates emphasize the need for rapid diagnostic tests to aid in patient management (1, 2).Over the past 2 decades, manufacturers have developed immunochromatographic rapid antigen detection tests (RADTs) that detect the polysaccharide C cell-wall antigen of bacteria. These tests are now widely used for diagnosing pharyngitis in pediatric outpatient clinics and private practices, which has considerably reduced the number of antibiotic prescriptions and resulted in fewer throat cultures performed by laboratories (3-5).Extending their indication beyond this intended use, namely, on deep-seated samples, may reduce delays in the diagnosis of invasive infections. To this end, we evaluated the performances of three commercially available RADTs approved for pharyngitis in the diagnosis of invasive GAS infections and compared them with those of conventional culture and molecular techniques. MATERIALS AND METHODSPatients and clinical specimens. This survey was conducted by three teaching hospitals (in Lyon, Grenoble, and Saint-Etienne, France) between May 2013 a...

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Section: Discussionmentioning

confidence: 99%

Reassessment of the Role of Rapid Antigen Detection Tests in Diagnosis of Invasive Group A Streptococcal Infections

et al. 2016

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“…Clindamycin is recommended for necrotizing fasciitis caused by S. pyogenes, based on its suppression of streptococcal toxins and two observational studies showing greater efficacy than with ␤-lactams (377,378). In an additional observational cohort, the addition of clindamycin was associated with reduced mortality due to invasive S. pyogenes infections (379). There are no such data available for S. aureus necrotizing fasciitis, and IDSA guidelines do not specifically recommend the addition of clindamycin in this setting (370).…”

Section: Treatmentmentioning

confidence: 99%

Staphylococcus aureus Infections: Epidemiology, Pathophysiology, Clinical Manifestations, and Management

et al. 2015

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SUMMARY Staphylococcus aureus is a major human pathogen that causes a wide range of clinical infections. It is a leading cause of bacteremia and infective endocarditis as well as osteoarticular, skin and soft tissue, pleuropulmonary, and device-related infections. This review comprehensively covers the epidemiology, pathophysiology, clinical manifestations, and management of each of these clinical entities. The past 2 decades have witnessed two clear shifts in the epidemiology of S. aureus infections: first, a growing number of health care-associated infections, particularly seen in infective endocarditis and prosthetic device infections, and second, an epidemic of community-associated skin and soft tissue infections driven by strains with certain virulence factors and resistance to β-lactam antibiotics. In reviewing the literature to support management strategies for these clinical manifestations, we also highlight the paucity of high-quality evidence for many key clinical questions.

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“…Consequently, regarding the research agenda on NSTIs, the IDSA guidelines strongly advocate the development of clinical trials, particularly aimed at assessing treatments targeting staphylococcal and streptococcal NSTIs. These subtypes of NSTIs may indeed present with the classical toxic shock syndrome, for which clindamycin should be combined with penicillin in order to suppress streptococcal/staphylococcal toxins as well as cytokine production [9]. In this setting, the efficacy of intravenous immunoglobulins (IVIG) remains debated [10].…”

mentioning

confidence: 99%

Therapeutic targets in necrotizing soft tissue infections

2017

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

Cited by 202 publications

References 27 publications

Reassessment of the Role of Rapid Antigen Detection Tests in Diagnosis of Invasive Group A Streptococcal Infections

Reassessment of the Role of Rapid Antigen Detection Tests in Diagnosis of Invasive Group A Streptococcal Infections

Staphylococcus aureus Infections: Epidemiology, Pathophysiology, Clinical Manifestations, and Management

Therapeutic targets in necrotizing soft tissue infections

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