Clindamycin reduced the odds of death in kids with iGAS infections in a national observational study.An observational study shows an association between adjunctive clindamycin and reduced odds of mortality in children with invasive Group A streptococcal (iGAS) infections.
Clindamycin reduced the odds of death in the logistic regression (adjusted odds ratio [aOR], 0.143; p=0.008), propensity–score (PS)-adjusted logistic regression (aOR, 0.27; p=0.045), and the IPTW*-adjusted analyses (aOR, 0.37; p=0.013). [ESPID 2026, abstract OP-059]
This was not the case for IV immunoglobulin (IVIG; logistic regression: aOR, 0.385; p=0.289; PS-adjusted: aOR, 1.07; p=0.944). “IVIG showed a nonsignificant trend towards reduced mortality,” noted Dr Ana Carolina Alves from Hospital de Santo André, Leiria, Portugal, at ESPID 2026.
Study characteristics
Group A streptococcus usually causes mild infections, but it may lead to severe diseases associated with high morbidity and mortality, such as necrotizing fasciitis and streptococcal toxic shock syndrome (STSS). [Int J Infect Dis 2023;135:84-90]
Penicillin is the treatment of choice for iGAS infections. Clindamycin and IVIG may be considered adjunctive therapies for severe iGAS infections, but there is insufficient evidence to support their efficacy in this setting. [Lancet Infect Dis 2021;21:697-710]
Alves and colleagues evaluated 349 children with iGAS infections (median age 3 years, 53.9 percent male). All kids received a β-lactam antibiotic. As adjunctive therapy, 49.8 percent of participants received clindamycin (group 1), 7.2 percent received clindamycin plus IVIG (group 2), and 43 percent received neither (group 3).
Group 2 had elevated C-reactive protein and creatinine levels at baseline (208.5 g/L and 0.6 mg/dL, respectively), and 28.6 percent were hypotensive on admission.
Compared with groups 1 and 3, group 2 had the highest rates of sepsis (68 percent vs 20.1 percent and 14.7 percent), STSS (56 percent vs 11.6 percent and 6.7 percent), pneumonia (52 percent vs 25.3 percent and 13.3 percent), and necrotizing fasciitis (20 percent vs 5.8 percent and 0.7 percent).
Group 2 also had significantly higher rates of coagulopathies (45.8 percent vs 9.9 percent and 4.1 percent), respiratory failure (39.1 percent vs 4.7 percent and 3.5 percent), multiorgan failure (37.5 percent vs 8.8 percent and 6.1 percent), and hepatic dysfunction (17.4 percent vs 6.4 percent and 2.7 percent) than groups 1 and 3.
Moreover, group 2 had a longer length of hospital stay (20.5 vs 10 [group 1] and 6 days [group 3]) and duration of IV antibiotics (21 vs 10 vs 7 days), and higher rates of surgery or drainage (56 percent vs 46.6 percent and 29.3 percent) and PICU admission (84 percent vs 24.1 percent and 14 percent).
Between participants who did and did not receive clindamycin, the former had a higher incidence of multiorgan failure (12.3 percent vs 6.1 percent; p=0.05) and PICU admission (31.7 percent vs 14 percent; p<0.001) but a numerically lower incidence of deaths (3.2 percent vs 6.5 percent; p=0.17) than the latter.
In the IVIG vs no IVIG comparison, multiorgan failure, PICU admission, and mortality rates were higher in the former group than in the latter (37.5 percent vs 7.5 percent; p<0.001; 84 percent vs 19.4 percent; p<0.001; and 8.7 percent vs 4.3 percent; p=0.289, respectively).
Adjunctive therapy in iGAS infections
“Overall, patients treated with adjunctive clindamycin or IVIG had more severe disease, with higher complication rates, increased need for PICU admission, and longer length of stay and antibiotic treatment,” Alves said.
“Nonetheless, clindamycin administration was associated with a reduced odds of mortality, even after adjusting for disease severity. This suggests that clindamycin could be considered as an adjunctive therapy in iGAS infections,” Alves continued.
Alves called for larger studies with more representative samples to validate the effect of adjunctive IVIG therapy in this setting.