Clindamycin Use in Patients With Necrotizing Fasciitis Presenting to the Emergency Department

Necrotizing fasciitis (NF) is a life-threatening infection with high morbidity and mortality. Clindamycin is recommended as adjunctive therapy principally due to its ability to inhibit bacterial toxin production. However, there is a paucity of evidence about Clindamycin utilization among emergency department (ED) patients with NF. Our objective is to characterize the usage of Clindamycin and assess for association with hypotension and operative management.

We conducted a retrospective cohort study of adult patients diagnosed with NF presenting to the ED at a large tertiary care center between 2010 and 2024, with an annual ED census exceeding 100,000 visits and 24/7 access to acute care surgery. Demographic characteristics, comorbidities, presenting systolic blood pressure, antibiotic therapy, and operative intervention during hospitalization were abstracted. Patients were stratified by receipt of clindamycin on presentation. Descriptive statistics were performed, followed by multivariable logistic regression analyses to evaluate associations between clindamycin use and hypotension on presentation as well as operative intervention.

A total of 738 patients were included; the mean age was 58.6 years (SD 14.7), and 58.7% were male. Clindamycin was administered to 56.2% of patients. Among patients who received clindamycin on presentation, hypotension occurred in 30.9%, and 73.1% underwent operative intervention during hospitalization. Broad-spectrum antibiotic therapy was administered to 41.1% of patients. In multivariable analyses adjusting for age, sex, comorbidities, and antibiotic burden, clindamycin use remained associated with hypotension and operative intervention.

In this large cohort of patients with necrotizing fasciitis, clindamycin was frequently administered and was associated with hypotension and broader antibiotic exposure, suggesting preferential use in patients with more severe clinical presentations. These findings highlight current ED prescribing patterns and underscore the need for future studies to better define the role of clindamycin in necrotizing fasciitis management.