Skip Navigation LinksHome > June 2007 - Volume 35 - Issue 6 > Combination antibiotic therapy improves survival in patients...
Critical Care Medicine:
doi: 10.1097/01.CCM.0000266755.75844.05
Continuing Medical Education Article

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

Rodríguez, Alejandro MD, PhD; Mendia, Angel MD; Sirvent, Josep-María MD, PhD; Barcenilla, Fernando MD; de la Torre-Prados, María Victoria MD, PhD; Solé-Violán, Jordi MD, PhD; Rello, Jordi MD, PhD; for the CAPUCI Study Group

Continued Medical Education
Collapse Box

Abstract

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.

© 2007 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins

Article Tools

Share

Article Level Metrics

Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.