Effect of Adequate Single-Drug vs Combination Antimicrobial Therapy on Mortality in Pseudomonas aeruginosa Bloodstream Infections: A Post Hoc Analysis of a Prospective Cohort

February 19, 2017 at 11:40 am

Clinical Infectious Diseases July 15, 2013 V.57 N.2 P.208-216

Carmen Peña, Cristina Suarez, Alain Ocampo-Sosa, Javier Murillas, Benito Almirante, Virginia Pomar, Manuela Aguilar, Ana Granados, Esther Calbo, Jesús Rodríguez-Baño, Fernando Rodríguez, Fe Tubau, Antonio Oliver, Luis Martínez-Martínez, and for the Spanish Network for Research in Infectious Diseases (REIPI)

1Servicio de Enfermedades Infecciosas, Hospital Universitario de Bellvitge–IDIBELL, Barcelona

2Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla–IFIMAV, Santander

3Servicio de Microbiología y Unidad de Enfermedades Infecciosas, Hospital Universitario de Son Espases, Palma de Mallorca

4Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d’Hebrón

5Unidad de Enfermedades Infecciosas, Hospital Santa Creu i Sant Pau, Barcelona

6Servicio de Enfermedades Infecciosas, Hospital Universitario Virgen del Rocío, Sevilla

7Sección de Enfermedades Infecciosas, Consorci Hospitalari Parc Taulí, Sabadell

8Sección de Enfermedades Infecciosas, Hospital Mutua de Terrasa

9Sección de Enfermedades Infecciosas, Hospital Universitario Virgen Macarena, Sevilla

10Servicio de Microbiología Infecciosas, Hospital Universitario Reina Sofía–IMIBIC, Córdoba

11Departamento de Biología Molecular, Universidad de Cantabria, Santander, Spain

Background

Empirical combination therapy is recommended for patients with known or suspected Pseudomonas aeruginosa (PA) infection as a means to decrease the likelihood of administering inadequate antimicrobial treatment, to prevent the emergence of resistance, and to achieve a possible additive or even synergistic effect.

Methods

We performed a post hoc analysis of patients with PA bloodstream infections from a published prospective cohort. Mortality was compared in patients treated with adequate empirical and definitive combination therapy (AECT, ADCT), and adequate empirical and definitive single-drug therapy (AESD, ADSD). Confounding was controlled by Cox regression analysis, and a propensity score for receiving AECT or ADCT was also used.

Results

The final cohort comprised 593 patients with a single episode of PA bacteremia. The 30-day mortality was 30% (176 patients); 76 patients (13%) died during the first 48 hours. The unadjusted probabilities of survival until day 30 were 69.4% (95% confidence interval [CI], 59.1–81.6) for the patients receiving AECT, 73.5% (95% CI, 68.4%–79.0%) for the AESD group, and 66.7% (95% CI, 61.2%–72.7%) for patients who received inadequate empirical therapy (P = .17, log-rank test). After adjustment for confounders, the AESD group (adjusted hazard ratio [AHR], 1.17; 95% CI, .70–1.96; P = .54) and patients who received ADSD (AHR, 1.34; 95% CI, .73–2.47; P = .35) showed no association with 30-day mortality compared with the AECT and ADCT groups, respectively.

Conclusions

These results suggests that treatment with combination antimicrobial therapy did not reduce the mortality risk compared with single-drug therapy in PA bloodstream infections. Empirical combination therapy is recommended for patients with known or suspected Pseudomonas aeruginosa (PA). A post hoc analysis of patients with PA bloodstream infections suggests that treatment with combination antimicrobial therapy did not reduce the mortality risk compared with single-drug therapy.

PDF

http://cid.oxfordjournals.org/content/57/2/208.full.pdf

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Entry filed under: Antimicrobianos, Bacterias, Bacteriemias, Metodos diagnosticos, REPORTS, Resistencia bacteriana.

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