Adjunctive clindamycin therapy in invasive ?-haemolytic streptococcal infections – Authors' reply

We thank Huan Zhang and Yun Cai for their comments on our Article.1Babiker A Li X Lai YL et al.Effectiveness of adjunctive clindamycin in ?-lactam antibiotic-treated patients with invasive ?-haemolytic streptococcal infections US hospitals: a retrospective multicentre cohort study.Lancet Infect Dis. 2021; 21: 697-710Summary Full Text PDF PubMed Scopus (9) Google Scholar Despite growing concerns its role the aetiology infections, we chose to exclude group B streptococcus (iGBS) from non-group pathogens. As reported Article, this decision was primarily driven by low use (6·6%) observed subgroup. raise possibility that A/B (iNABS) heterogenous composed many different species, perhaps against any one individual iNABS species lower than iGBS. However, not case. detailed Article's appendix, 90% among were caused either G (511 877) or C (281 streptococci. Furthermore, streptococci fairly similar at 14·9% (42 281) 13·1% (67 511), respectively, more twice Also mentioned Cai, rates resistance iGBS USA (42%) are substantially higher those (iGAS; 23%).2US Centers Disease Control PreventionAntibiotic threats United States: 2019.https://www.cdc.gov/drugresistance/pdf/threats-report/2019-ar-threats-report-508.pdfDate: Nov 13, 2019Date accessed: March 26, 2021Google Accordingly, results cannot be generalised nor can they support infected iNABS. To clear, is adequately supported available evidence. fully agree differences baseline susceptibility might have contributed risk-adjusted odds mortality iGAS versus Although clindamycin-resistant isolates excluded analysis, data indeed infrequently real-world database used study. Clearly, impact effectiveness iGAS, iNABS, warrants further investigation, as Article. Notwithstanding, presence resistance, which known majority cohort, led unmeasured confounding, acknowledged limitation Importantly, study findings should applied local antibiograms mind, especially geographical areas high clindamycin. also cite concern absence reporting duration therapy. therapy equated In clinical practice, frequently administered until clinically stable, after monotherapy continued. This approach evident represents practices. second-largest topic, received median 5 days,3Couture-Cossette Carignan Mercier Desruisseaux Valiquette L Pépin J Secular trends incidence beta-hemolytic efficacy Quebec, Canada, 1996–2016.PloS One. 2018; 13e0206289Crossref (6) supports findings. Notably, traditional 7–14 day antibiotic courses historically assigned basis few no unnecessary most acute bacterial infections.4Spellberg The maturing mantra: “shorter still better”.J Hosp Med. 13: 361-362PubMed Results recent randomised controlled trials suggested shorter safe effective selected across range including pneumonia, pyelonephritis, intra-abdominal skin soft tissue infections.5Royer S DeMerle KM Dickson RP Prescott HC Shorter longer antibiotics infection hospitalized patients: systematic review meta-analysis.J 336-342PubMed Hence, it unlikely influenced overall study, given both cohorts well balanced severity illness. Finally, authors bringing attention error figure, submitted an erratum. numbers cited text represent correct ratio p value without vasopressor-dependent shock necrotising fasciitis formed conclusions. Given global burden disease, look forward observational studies translational research field. hope such endeavors inform design future trials. declare competing interests. opinions expressed Correspondence do position policy National Institutes Health, Department Health Human Services, Government. Effectiveness studyReal-world suggest increased but could improve outcomes, even fasciitis. Full-Text Adjunctive infectionsWe read interest Article Ahmed Babiker colleagues,1 investigated (iGAS) infections. colleagues found significantly reduced finding great progress, some about interpretation results.