While my shop does not observe or admit a large number of cellulitis patients, though this study makes me pause to consider my future treatment plans.
A retrospective analysis of 269 patients admitted to a 941 bed Alabama hospital with an acute bacterial skin or skin-structure infection were evaluated based on administration of either vancomycin monotherapy or vancomycin & clindamycin combination therapy. The primary outcome was hospital length of stay, with 90 day readmission rate as a secondary outcome.
For all-comers, LOS was similar, though there were fewer 90-day readmissions (5.3% vs 15.3%) in the combination therapy arm. However, subgroup analysis revealed that, for patients with an abscess, combination therapy was associated with an 18.2% decrease in LOS, as well as an impressive decrease in 90 day readmissions (2% vs 24.3% ! – OR 14.6 !!!!).
First, this is a subgroup analysis of a retrospective analysis of a single center, so let’s hold our horses a bit. Second, a 90 day readmission rate is a long time, but at 24.3%, that seems quite high. Third, I am unsure of what the local antibiogram looks like for Northern Alabama, so I’m not certain if clindamycin would be the best choice everywhere. Lastly, why are we admitting these patients for so long? Why not consider nsaids or steroids to decrease LOS – or admissions?