Assessment of in Vitro Antimicrobial Activity of Clindamycin Metabolites Against Staphylococcus Species.

Orthopaedic and trauma device-related infection is a major complication in modern musculoskeletal surgery. Treatment of these infections remains difficult and involves surgical intervention followed by a prolonged course of multiple antibiotics. Staphylococci are the main causative pathogens and are known to form a biofilm on the surface of implant devices, which complicates antibiotic penetration and host immune response, resulting in increased risk for therapy failure. The duration of antibiotic therapy in orthopaedic and trauma device-related infections is long, i.e. 3 months, requiring oral antimicrobial treatment. Combination antimicrobial therapy with rifampicin and clindamycin is regularly used to treat these infections. However, this combination is actually a matter of debate, because rifampicin is a potent cytochrome P450 (CYP) inducer and enhances the metabolism of clindamycin. Several studies have demonstrated a significant reduction in clindamycin serum concentrations among patients receiving concurrent therapy with rifampicin [ 1 Zeller V. Magreault S. Heym B. Salmon D. Kitzis M.D. Billaud E. et al. Influence of the clindamycin administration route on the magnitude of clindamycin-rifampicin interaction: a prospective pharmacokinetic study. Clin Microbiol Infect. 2021; 27 (e1–7): 1857https://doi.org/10.1016/j.cmi.2021.04.017 Abstract Full Text Full Text PDF Scopus (8) Google Scholar , 2 Bernard A. Kermarrec G. Parize P. Caruba T. Bouvet A. Mainardi J.L. et al. Dramatic reduction of clindamycin serum concentration in staphylococcal osteoarticular infection patients treated with the oral clindamycin-rifampicin combination. J Infect. 2015; 71: 200-206https://doi.org/10.1016/j.jinf.2015.03.013 Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar , 3 Curis E. Pestre V. Jullien V. Eyrolle L. Archambeau D. Morand P. et al. Pharmacokinetic variability of clindamycin and influence of rifampicin on clindamycin concentration in patients with bone and joint infections. Infection. 2015; 43: 473-481https://doi.org/10.1007/s15010-015-0773-y Crossref PubMed Scopus (26) Google Scholar ].