Relationship Between Intralesional Clindamycin and Development of Gastrointestinal Clostridioides difficile Infection After Dermatologic Surgery

BACKGROUND: Oral clindamycin is associated with colonization by Clostridioides difficile (C. difficile). No data have been reported on the incidence of C. difficile infection in patients receiving intraincisional clindamycin. OBJECTIVE: The goal of this study was to evaluate the incidence of C. difficile infection in dermatologic surgery patients treated with intraincisional clindamycin, compared with patients who did not receive intraincisional clindamycin and with historical rates reported for oral clindamycin. MATERIALS AND METHODS: Dermatologic surgery patients were grouped by whether they received intralesional clindamycin. Patients' records were searched for "C. difficile" or analogous terms. The groups were compared with one another and historical rates reported for oral clindamycin. RESULTS: There was no significant difference in the rate of C. difficile infections between the intralesional clindamycin (N = 9) and no intralesional clindamycin (N = 6) cohorts (χ2 [1, N = 15] = 0.31, p = .57) or any of their stratified groups. There was a significant difference in infection rate between the group receiving neither intralesional nor oral clindamycin (N = 3) and historical rate reported for oral clindamycin (N = 92) (χ2 [1, N = 95] = 5.81, p = .01). There was also a significant difference in the infection rate between the group receiving intralesional clindamycin without oral antibiotics (N = 4) and the historical rate reported for oral clindamycin (χ2 [1, N = 96] = 3.71, p = .05). CONCLUSION: There was no difference in the rate of C. difficile infection between the cohort receiving intralesional clindamycin and those not. However, patients who received no form of antibiotics or intralesional clindamycin without oral antibiotics had significantly lower infection rates than the historical rates reported for oral clindamycin.