Linezolid versus clindamycin for toxin inhibition in severe skin and soft tissue infections: a systematic review and meta-analysis.

PURPOSE: Necrotizing soft tissue infections (NSTIs) are life-threatening infections often caused by toxin-producing bacteria. Clindamycin has historically been favoured for its toxin-inhibiting properties but increasing resistance and adverse effects have prompted interest in alternatives. This study evaluates the efficacy and safety of linezolid versus clindamycin plus anti-gram-positive therapy in patients with severe or necrotizing skin and soft tissue infections (SSTIs).

METHODS

A systematic literature search through December 12, 2024, was conducted across eight databases and clinical trial registries. Studies comparing linezolid-containing regimens to clindamycin plus anti-gram-positive therapy in patients with severe SSTIs were included. Outcomes of interest included ICU length of stay (LOS), hospital LOS, mortality, ventilator days, vasopressor days, antimicrobial duration, and adverse effects. Random-effects meta-analyses were performed for ICU LOS and hospital LOS.

RESULTS

Of 310 articles screened, four retrospective studies met inclusion criteria. Moderate to significant risk of bias was present. No significant differences were observed in ICU LOS (mean difference [MD]: -0.001 days; 95% CI: -1.110 to 1.107; p = 0.998; I2 = 0.8%) or hospital LOS (MD: -2.797 days; 95% CI: -7.027 to 1.433; p = 0.195). Two studies reported lower rates of acute kidney injury (AKI) with linezolid. Mortality data were limited. No other significant differences were found.

CONCLUSIONS

No significant difference in ICU and hospital length of stay were noted between linezolid and clindamycin-based regimens. Lower rates of AKI were reported with linezolid. However, given the study design and potential risk of bias these results should be interpreted with caution.