Combination antibiotic therapy improves survival in patients with community-acquired pneumonia and shock

• Published in: Critical care medicine Vol. 35; no. 6; pp. 1493 - 1498
• Main Authors: Rodríguez, Alejandro, Mendia, Angel, Sirvent, Josep-María, Barcenilla, Fernando, de la Torre-Prados, María Victoria, Solé-Violán, Jordi, Rello, Jordi
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD by the Society of Critical Care Medicine and Lippincott Williams & Wilkins 01-06-2007; Lippincott
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - therapeutic use; Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Biological and medical sciences; Community-Acquired Infections - complications; Community-Acquired Infections - drug therapy; Community-Acquired Infections - mortality; Drug Therapy, Combination; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Female; Hospital Mortality; Humans; Intensive care medicine; Intensive Care Units; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Pneumonia, Bacterial - complications; Pneumonia, Bacterial - drug therapy; Pneumonia, Bacterial - mortality; Prospective Studies; Shock - drug therapy; Shock - etiology; Survival Analysis; Human; Pneumonia shock; Lung disease; Drug combination; Pneumonia; Intensive care; Respiratory disease; community-acquired pneumonia; Macrolide; Survival; Bacteremia; Streptococcus pneumoniae; Infection; Streptococcaceae; Antibiotic; Respiratory failure; Bacteriosis; Bacteria; Micrococcales; combination therapy; Combined treatment; Protein synthesis inhibitor; Resuscitation
• ISSN: 0090-3493; 1530-0293
• DOI: 10.1097/01.CCM.0000266755.75844.05

OBJECTIVE:To assess whether combination antibiotic therapy improves outcome of severe community-acquired pneumonia in the subset of patients with shock.
DESIGN:Secondary analysis of a prospective observational, cohort study.
SETTING:Thirty-three intensive care units (ICUs) in Spain.
PATIENTS:Patients were 529 adults with community-acquired pneumonia requiring ICU admission.
INTERVENTIONS:None.
MEASUREMENT AND MAIN RESULTS:Two hundred and seventy (51%) patients required vasoactive drugs and were categorized as having shock. The effects of combination antibiotic therapy and monotherapy on survival were compared using univariate analysis and a Cox regression model. The adjusted 28-day in-ICU mortality was similar (p = .99) for combination antibiotic therapy and monotherapy in the absence of shock. However, in patients with shock, combination antibiotic therapy was associated with significantly higher adjusted 28-day in-ICU survival (hazard ratio, 1.69; 95% confidence interval, 1.09–2.60; p = .01) in a Cox hazard regression model. Even when monotherapy was appropriate, it achieved a lower 28-day in-ICU survival than an adequate antibiotic combination (hazard ratio, 1.64; 95% confidence interval, 1.01–2.64).
CONCLUSIONS:Combination antibiotic therapy does not seem to increase ICU survival in all patients with severe community-acquired pneumonia. However, in the subset of patients with shock, combination antibiotic therapy improves survival rates.