NSTI Anbx coverage

Q: Which of the following is appropriate for the initial antibiotic treatment of necrotizing soft tissue infections (NSTI) - select one

A) Vancomycin

B) Clindamycin

C) Piperacillin-tazobactam

D) Vancomycin, Piperacillin-tazobactam and Clindamycin

E) Vancomycin, Clindamycin and Metronidazole

Answer: D

The most important intervention besides calling surgical service in NSTI is the initiation of antibiotics at the earliest. It is important to broadly cover gram-negative and gram-positive organisms with piperacillin-tazobactam or carbapenem. Vancomycin or daptomycin should be added to cover methicillin-resistant Staphylococcus aureus (MRSA).

Clindamycin should be added to the regimen as an anti-ribosomal agent to inhibit exotoxin production. 

Choices A, B, and E have no gram-negative coverage and are incorrect.

Choice C has no anti-ribosomal activity and is incorrect.

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References:

1. Louis A, Savage S, Utter GH, et al. NSTI Organisms and Regions: A Multicenter Study From the American Association for the Surgery of Trauma. J Surg Res 2019; 243:108.

2. Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. Clin Infect Dis 2014; 59:147.

3. Zimbelman J, Palmer A, Todd J. Improved outcome of clindamycin compared with beta-lactam antibiotic treatment for invasive Streptococcus pyogenes infection. Pediatr Infect Dis J 1999; 18:1096.